Bill Text: IL SB1773 | 2017-2018 | 100th General Assembly | Chaptered


Bill Title: Amends the Medical Assistance Article of the Illinois Public Aid Code. In a provision permitting a nursing facility to appeal a change in its Minimum Data Set rate, provides that the facility shall be permitted to offer any and all additional documentation during the appeal hearing that is necessary to refute the State's findings (rather than the facility may not offer any additional documentation during the appeal hearing, but may identify documentation provided during the on-site review that may support a specific area of documentation deemed deficient by the Department of Healthcare and Family Services).

Spectrum: Slight Partisan Bill (Democrat 11-4)

Status: (Passed) 2018-03-12 - Public Act . . . . . . . . . 100-0581 [SB1773 Detail]

Download: Illinois-2017-SB1773-Chaptered.html



Public Act 100-0581
SB1773 EnrolledLRB100 09919 KTG 20090 b
AN ACT concerning public aid.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 1. Legislative intent. The General Assembly
declares that is the legislative intent of the 100th General
Assembly that, in order to best preserve and improve access to
hospital services for Illinois Medicaid beneficiaries, the
assessment imposed and payments required under this Act are to
be presented to the federal Centers for Medicare and Medicaid
Services as a 6-year program.
In accordance with guidelines promulgated by the federal
Centers for Medicare and Medicaid Services, the assessment plan
presented shall phase in claims-based payments through
increasing amounts over 6 years. The Department of Healthcare
and Family Services, in consultation with the Hospital
Transformation Review Committee, the hospital community, and
the managed care organizations contracting with the State to
provide medicaid services, shall evaluate the State fiscal year
claims-based payments to monitor whether the proposed rates and
methodologies resulted in expected reimbursement estimates,
taking into consideration any changes in utilization patterns.
Section 2. The Illinois Administrative Procedure Act is
amended by changing Section 5-45 and by adding Section 5-46.3
as follows:
(5 ILCS 100/5-45) (from Ch. 127, par. 1005-45)
Sec. 5-45. Emergency rulemaking.
(a) "Emergency" means the existence of any situation that
any agency finds reasonably constitutes a threat to the public
interest, safety, or welfare.
(b) If any agency finds that an emergency exists that
requires adoption of a rule upon fewer days than is required by
Section 5-40 and states in writing its reasons for that
finding, the agency may adopt an emergency rule without prior
notice or hearing upon filing a notice of emergency rulemaking
with the Secretary of State under Section 5-70. The notice
shall include the text of the emergency rule and shall be
published in the Illinois Register. Consent orders or other
court orders adopting settlements negotiated by an agency may
be adopted under this Section. Subject to applicable
constitutional or statutory provisions, an emergency rule
becomes effective immediately upon filing under Section 5-65 or
at a stated date less than 10 days thereafter. The agency's
finding and a statement of the specific reasons for the finding
shall be filed with the rule. The agency shall take reasonable
and appropriate measures to make emergency rules known to the
persons who may be affected by them.
(c) An emergency rule may be effective for a period of not
longer than 150 days, but the agency's authority to adopt an
identical rule under Section 5-40 is not precluded. No
emergency rule may be adopted more than once in any 24-month
period, except that this limitation on the number of emergency
rules that may be adopted in a 24-month period does not apply
to (i) emergency rules that make additions to and deletions
from the Drug Manual under Section 5-5.16 of the Illinois
Public Aid Code or the generic drug formulary under Section
3.14 of the Illinois Food, Drug and Cosmetic Act, (ii)
emergency rules adopted by the Pollution Control Board before
July 1, 1997 to implement portions of the Livestock Management
Facilities Act, (iii) emergency rules adopted by the Illinois
Department of Public Health under subsections (a) through (i)
of Section 2 of the Department of Public Health Act when
necessary to protect the public's health, (iv) emergency rules
adopted pursuant to subsection (n) of this Section, (v)
emergency rules adopted pursuant to subsection (o) of this
Section, or (vi) emergency rules adopted pursuant to subsection
(c-5) of this Section. Two or more emergency rules having
substantially the same purpose and effect shall be deemed to be
a single rule for purposes of this Section.
(c-5) To facilitate the maintenance of the program of group
health benefits provided to annuitants, survivors, and retired
employees under the State Employees Group Insurance Act of
1971, rules to alter the contributions to be paid by the State,
annuitants, survivors, retired employees, or any combination
of those entities, for that program of group health benefits,
shall be adopted as emergency rules. The adoption of those
rules shall be considered an emergency and necessary for the
public interest, safety, and welfare.
(d) In order to provide for the expeditious and timely
implementation of the State's fiscal year 1999 budget,
emergency rules to implement any provision of Public Act 90-587
or 90-588 or any other budget initiative for fiscal year 1999
may be adopted in accordance with this Section by the agency
charged with administering that provision or initiative,
except that the 24-month limitation on the adoption of
emergency rules and the provisions of Sections 5-115 and 5-125
do not apply to rules adopted under this subsection (d). The
adoption of emergency rules authorized by this subsection (d)
shall be deemed to be necessary for the public interest,
safety, and welfare.
(e) In order to provide for the expeditious and timely
implementation of the State's fiscal year 2000 budget,
emergency rules to implement any provision of Public Act 91-24
or any other budget initiative for fiscal year 2000 may be
adopted in accordance with this Section by the agency charged
with administering that provision or initiative, except that
the 24-month limitation on the adoption of emergency rules and
the provisions of Sections 5-115 and 5-125 do not apply to
rules adopted under this subsection (e). The adoption of
emergency rules authorized by this subsection (e) shall be
deemed to be necessary for the public interest, safety, and
welfare.
(f) In order to provide for the expeditious and timely
implementation of the State's fiscal year 2001 budget,
emergency rules to implement any provision of Public Act 91-712
or any other budget initiative for fiscal year 2001 may be
adopted in accordance with this Section by the agency charged
with administering that provision or initiative, except that
the 24-month limitation on the adoption of emergency rules and
the provisions of Sections 5-115 and 5-125 do not apply to
rules adopted under this subsection (f). The adoption of
emergency rules authorized by this subsection (f) shall be
deemed to be necessary for the public interest, safety, and
welfare.
(g) In order to provide for the expeditious and timely
implementation of the State's fiscal year 2002 budget,
emergency rules to implement any provision of Public Act 92-10
or any other budget initiative for fiscal year 2002 may be
adopted in accordance with this Section by the agency charged
with administering that provision or initiative, except that
the 24-month limitation on the adoption of emergency rules and
the provisions of Sections 5-115 and 5-125 do not apply to
rules adopted under this subsection (g). The adoption of
emergency rules authorized by this subsection (g) shall be
deemed to be necessary for the public interest, safety, and
welfare.
(h) In order to provide for the expeditious and timely
implementation of the State's fiscal year 2003 budget,
emergency rules to implement any provision of Public Act 92-597
or any other budget initiative for fiscal year 2003 may be
adopted in accordance with this Section by the agency charged
with administering that provision or initiative, except that
the 24-month limitation on the adoption of emergency rules and
the provisions of Sections 5-115 and 5-125 do not apply to
rules adopted under this subsection (h). The adoption of
emergency rules authorized by this subsection (h) shall be
deemed to be necessary for the public interest, safety, and
welfare.
(i) In order to provide for the expeditious and timely
implementation of the State's fiscal year 2004 budget,
emergency rules to implement any provision of Public Act 93-20
or any other budget initiative for fiscal year 2004 may be
adopted in accordance with this Section by the agency charged
with administering that provision or initiative, except that
the 24-month limitation on the adoption of emergency rules and
the provisions of Sections 5-115 and 5-125 do not apply to
rules adopted under this subsection (i). The adoption of
emergency rules authorized by this subsection (i) shall be
deemed to be necessary for the public interest, safety, and
welfare.
(j) In order to provide for the expeditious and timely
implementation of the provisions of the State's fiscal year
2005 budget as provided under the Fiscal Year 2005 Budget
Implementation (Human Services) Act, emergency rules to
implement any provision of the Fiscal Year 2005 Budget
Implementation (Human Services) Act may be adopted in
accordance with this Section by the agency charged with
administering that provision, except that the 24-month
limitation on the adoption of emergency rules and the
provisions of Sections 5-115 and 5-125 do not apply to rules
adopted under this subsection (j). The Department of Public Aid
may also adopt rules under this subsection (j) necessary to
administer the Illinois Public Aid Code and the Children's
Health Insurance Program Act. The adoption of emergency rules
authorized by this subsection (j) shall be deemed to be
necessary for the public interest, safety, and welfare.
(k) In order to provide for the expeditious and timely
implementation of the provisions of the State's fiscal year
2006 budget, emergency rules to implement any provision of
Public Act 94-48 or any other budget initiative for fiscal year
2006 may be adopted in accordance with this Section by the
agency charged with administering that provision or
initiative, except that the 24-month limitation on the adoption
of emergency rules and the provisions of Sections 5-115 and
5-125 do not apply to rules adopted under this subsection (k).
The Department of Healthcare and Family Services may also adopt
rules under this subsection (k) necessary to administer the
Illinois Public Aid Code, the Senior Citizens and Persons with
Disabilities Property Tax Relief Act, the Senior Citizens and
Disabled Persons Prescription Drug Discount Program Act (now
the Illinois Prescription Drug Discount Program Act), and the
Children's Health Insurance Program Act. The adoption of
emergency rules authorized by this subsection (k) shall be
deemed to be necessary for the public interest, safety, and
welfare.
(l) In order to provide for the expeditious and timely
implementation of the provisions of the State's fiscal year
2007 budget, the Department of Healthcare and Family Services
may adopt emergency rules during fiscal year 2007, including
rules effective July 1, 2007, in accordance with this
subsection to the extent necessary to administer the
Department's responsibilities with respect to amendments to
the State plans and Illinois waivers approved by the federal
Centers for Medicare and Medicaid Services necessitated by the
requirements of Title XIX and Title XXI of the federal Social
Security Act. The adoption of emergency rules authorized by
this subsection (l) shall be deemed to be necessary for the
public interest, safety, and welfare.
(m) In order to provide for the expeditious and timely
implementation of the provisions of the State's fiscal year
2008 budget, the Department of Healthcare and Family Services
may adopt emergency rules during fiscal year 2008, including
rules effective July 1, 2008, in accordance with this
subsection to the extent necessary to administer the
Department's responsibilities with respect to amendments to
the State plans and Illinois waivers approved by the federal
Centers for Medicare and Medicaid Services necessitated by the
requirements of Title XIX and Title XXI of the federal Social
Security Act. The adoption of emergency rules authorized by
this subsection (m) shall be deemed to be necessary for the
public interest, safety, and welfare.
(n) In order to provide for the expeditious and timely
implementation of the provisions of the State's fiscal year
2010 budget, emergency rules to implement any provision of
Public Act 96-45 or any other budget initiative authorized by
the 96th General Assembly for fiscal year 2010 may be adopted
in accordance with this Section by the agency charged with
administering that provision or initiative. The adoption of
emergency rules authorized by this subsection (n) shall be
deemed to be necessary for the public interest, safety, and
welfare. The rulemaking authority granted in this subsection
(n) shall apply only to rules promulgated during Fiscal Year
2010.
(o) In order to provide for the expeditious and timely
implementation of the provisions of the State's fiscal year
2011 budget, emergency rules to implement any provision of
Public Act 96-958 or any other budget initiative authorized by
the 96th General Assembly for fiscal year 2011 may be adopted
in accordance with this Section by the agency charged with
administering that provision or initiative. The adoption of
emergency rules authorized by this subsection (o) is deemed to
be necessary for the public interest, safety, and welfare. The
rulemaking authority granted in this subsection (o) applies
only to rules promulgated on or after July 1, 2010 (the
effective date of Public Act 96-958) through June 30, 2011.
(p) In order to provide for the expeditious and timely
implementation of the provisions of Public Act 97-689,
emergency rules to implement any provision of Public Act 97-689
may be adopted in accordance with this subsection (p) by the
agency charged with administering that provision or
initiative. The 150-day limitation of the effective period of
emergency rules does not apply to rules adopted under this
subsection (p), and the effective period may continue through
June 30, 2013. The 24-month limitation on the adoption of
emergency rules does not apply to rules adopted under this
subsection (p). The adoption of emergency rules authorized by
this subsection (p) is deemed to be necessary for the public
interest, safety, and welfare.
(q) In order to provide for the expeditious and timely
implementation of the provisions of Articles 7, 8, 9, 11, and
12 of Public Act 98-104, emergency rules to implement any
provision of Articles 7, 8, 9, 11, and 12 of Public Act 98-104
may be adopted in accordance with this subsection (q) by the
agency charged with administering that provision or
initiative. The 24-month limitation on the adoption of
emergency rules does not apply to rules adopted under this
subsection (q). The adoption of emergency rules authorized by
this subsection (q) is deemed to be necessary for the public
interest, safety, and welfare.
(r) In order to provide for the expeditious and timely
implementation of the provisions of Public Act 98-651,
emergency rules to implement Public Act 98-651 may be adopted
in accordance with this subsection (r) by the Department of
Healthcare and Family Services. The 24-month limitation on the
adoption of emergency rules does not apply to rules adopted
under this subsection (r). The adoption of emergency rules
authorized by this subsection (r) is deemed to be necessary for
the public interest, safety, and welfare.
(s) In order to provide for the expeditious and timely
implementation of the provisions of Sections 5-5b.1 and 5A-2 of
the Illinois Public Aid Code, emergency rules to implement any
provision of Section 5-5b.1 or Section 5A-2 of the Illinois
Public Aid Code may be adopted in accordance with this
subsection (s) by the Department of Healthcare and Family
Services. The rulemaking authority granted in this subsection
(s) shall apply only to those rules adopted prior to July 1,
2015. Notwithstanding any other provision of this Section, any
emergency rule adopted under this subsection (s) shall only
apply to payments made for State fiscal year 2015. The adoption
of emergency rules authorized by this subsection (s) is deemed
to be necessary for the public interest, safety, and welfare.
(t) In order to provide for the expeditious and timely
implementation of the provisions of Article II of Public Act
99-6, emergency rules to implement the changes made by Article
II of Public Act 99-6 to the Emergency Telephone System Act may
be adopted in accordance with this subsection (t) by the
Department of State Police. The rulemaking authority granted in
this subsection (t) shall apply only to those rules adopted
prior to July 1, 2016. The 24-month limitation on the adoption
of emergency rules does not apply to rules adopted under this
subsection (t). The adoption of emergency rules authorized by
this subsection (t) is deemed to be necessary for the public
interest, safety, and welfare.
(u) In order to provide for the expeditious and timely
implementation of the provisions of the Burn Victims Relief
Act, emergency rules to implement any provision of the Act may
be adopted in accordance with this subsection (u) by the
Department of Insurance. The rulemaking authority granted in
this subsection (u) shall apply only to those rules adopted
prior to December 31, 2015. The adoption of emergency rules
authorized by this subsection (u) is deemed to be necessary for
the public interest, safety, and welfare.
(v) In order to provide for the expeditious and timely
implementation of the provisions of Public Act 99-516,
emergency rules to implement Public Act 99-516 may be adopted
in accordance with this subsection (v) by the Department of
Healthcare and Family Services. The 24-month limitation on the
adoption of emergency rules does not apply to rules adopted
under this subsection (v). The adoption of emergency rules
authorized by this subsection (v) is deemed to be necessary for
the public interest, safety, and welfare.
(w) In order to provide for the expeditious and timely
implementation of the provisions of Public Act 99-796,
emergency rules to implement the changes made by Public Act
99-796 may be adopted in accordance with this subsection (w) by
the Adjutant General. The adoption of emergency rules
authorized by this subsection (w) is deemed to be necessary for
the public interest, safety, and welfare.
(x) In order to provide for the expeditious and timely
implementation of the provisions of Public Act 99-906,
emergency rules to implement subsection (i) of Section 16-115D,
subsection (g) of Section 16-128A, and subsection (a) of
Section 16-128B of the Public Utilities Act may be adopted in
accordance with this subsection (x) by the Illinois Commerce
Commission. The rulemaking authority granted in this
subsection (x) shall apply only to those rules adopted within
180 days after June 1, 2017 (the effective date of Public Act
99-906). The adoption of emergency rules authorized by this
subsection (x) is deemed to be necessary for the public
interest, safety, and welfare.
(y) In order to provide for the expeditious and timely
implementation of the provisions of this amendatory Act of the
100th General Assembly, emergency rules to implement the
changes made by this amendatory Act of the 100th General
Assembly to Section 4.02 of the Illinois Act on Aging, Sections
5.5.4 and 5-5.4i of the Illinois Public Aid Code, Section 55-30
of the Alcoholism and Other Drug Abuse and Dependency Act, and
Sections 74 and 75 of the Mental Health and Developmental
Disabilities Administrative Act may be adopted in accordance
with this subsection (y) by the respective Department. The
adoption of emergency rules authorized by this subsection (y)
is deemed to be necessary for the public interest, safety, and
welfare.
(z) In order to provide for the expeditious and timely
implementation of the provisions of this amendatory Act of the
100th General Assembly, emergency rules to implement the
changes made by this amendatory Act of the 100th General
Assembly to Section 4.7 of the Lobbyist Registration Act may be
adopted in accordance with this subsection (z) by the Secretary
of State. The adoption of emergency rules authorized by this
subsection (z) is deemed to be necessary for the public
interest, safety, and welfare.
(aa) In order to provide for the expeditious and timely
initial implementation of the changes made to Articles 5, 5A,
12, and 14 of the Illinois Public Aid Code under the provisions
of this amendatory Act of the 100th General Assembly, the
Department of Healthcare and Family Services may adopt
emergency rules in accordance with this subsection (aa). The
24-month limitation on the adoption of emergency rules does not
apply to rules to initially implement the changes made to
Articles 5, 5A, 12, and 14 of the Illinois Public Aid Code
adopted under this subsection (aa). The adoption of emergency
rules authorized by this subsection (aa) is deemed to be
necessary for the public interest, safety, and welfare.
(Source: P.A. 99-2, eff. 3-26-15; 99-6, eff. 1-1-16; 99-143,
eff. 7-27-15; 99-455, eff. 1-1-16; 99-516, eff. 6-30-16;
99-642, eff. 7-28-16; 99-796, eff. 1-1-17; 99-906, eff. 6-1-17;
100-23, eff. 7-6-17; 100-554, eff. 11-16-17.)
(5 ILCS 100/5-46.3 new)
Sec. 5-46.3. Approval of rules to implement the hospital
transformation program. Notwithstanding any other provision of
this Act, the Department of Healthcare and Family Services may
not file, the Secretary of State may not accept, and the Joint
Committee on Administrative Rules may not consider any rules
adopted in accordance to subsection (d-5) of Section 14-12 of
the Illinois Public Aid Code unless the rules have been
approved by 9 of the 14 members of the Hospital Transformation
Review Committee created under subsection (d-5) of Section
14-12 of the Illinois Public Aid Code. Approval of the rules
shall be demonstrated by submission of a written document
signed by each of the 9 approving members. The Department of
Healthcare and Family Services shall submit the written
document with signatures, along with a certified copy of each
rule, to the Secretary of State.
Section 3. The Illinois Health Facilities Planning Act is
amended by changing Section 3 as follows:
(20 ILCS 3960/3) (from Ch. 111 1/2, par. 1153)
(Text of Section before amendment by P.A. 100-518)
(Section scheduled to be repealed on December 31, 2019)
Sec. 3. Definitions. As used in this Act:
"Health care facilities" means and includes the following
facilities, organizations, and related persons:
(1) An ambulatory surgical treatment center required
to be licensed pursuant to the Ambulatory Surgical
Treatment Center Act.
(2) An institution, place, building, or agency
required to be licensed pursuant to the Hospital Licensing
Act.
(3) Skilled and intermediate long term care facilities
licensed under the Nursing Home Care Act.
(A) If a demonstration project under the Nursing
Home Care Act applies for a certificate of need to
convert to a nursing facility, it shall meet the
licensure and certificate of need requirements in
effect as of the date of application.
(B) Except as provided in item (A) of this
subsection, this Act does not apply to facilities
granted waivers under Section 3-102.2 of the Nursing
Home Care Act.
(3.5) Skilled and intermediate care facilities
licensed under the ID/DD Community Care Act or the MC/DD
Act. No permit or exemption is required for a facility
licensed under the ID/DD Community Care Act or the MC/DD
Act prior to the reduction of the number of beds at a
facility. If there is a total reduction of beds at a
facility licensed under the ID/DD Community Care Act or the
MC/DD Act, this is a discontinuation or closure of the
facility. If a facility licensed under the ID/DD Community
Care Act or the MC/DD Act reduces the number of beds or
discontinues the facility, that facility must notify the
Board as provided in Section 14.1 of this Act.
(3.7) Facilities licensed under the Specialized Mental
Health Rehabilitation Act of 2013.
(4) Hospitals, nursing homes, ambulatory surgical
treatment centers, or kidney disease treatment centers
maintained by the State or any department or agency
thereof.
(5) Kidney disease treatment centers, including a
free-standing hemodialysis unit required to be licensed
under the End Stage Renal Disease Facility Act.
(A) This Act does not apply to a dialysis facility
that provides only dialysis training, support, and
related services to individuals with end stage renal
disease who have elected to receive home dialysis.
(B) This Act does not apply to a dialysis unit
located in a licensed nursing home that offers or
provides dialysis-related services to residents with
end stage renal disease who have elected to receive
home dialysis within the nursing home.
(C) The Board, however, may require dialysis
facilities and licensed nursing homes under items (A)
and (B) of this subsection to report statistical
information on a quarterly basis to the Board to be
used by the Board to conduct analyses on the need for
proposed kidney disease treatment centers.
(6) An institution, place, building, or room used for
the performance of outpatient surgical procedures that is
leased, owned, or operated by or on behalf of an
out-of-state facility.
(7) An institution, place, building, or room used for
provision of a health care category of service, including,
but not limited to, cardiac catheterization and open heart
surgery.
(8) An institution, place, building, or room housing
major medical equipment used in the direct clinical
diagnosis or treatment of patients, and whose project cost
is in excess of the capital expenditure minimum.
"Health care facilities" does not include the following
entities or facility transactions:
(1) Federally-owned facilities.
(2) Facilities used solely for healing by prayer or
spiritual means.
(3) An existing facility located on any campus facility
as defined in Section 5-5.8b of the Illinois Public Aid
Code, provided that the campus facility encompasses 30 or
more contiguous acres and that the new or renovated
facility is intended for use by a licensed residential
facility.
(4) Facilities licensed under the Supportive
Residences Licensing Act or the Assisted Living and Shared
Housing Act.
(5) Facilities designated as supportive living
facilities that are in good standing with the program
established under Section 5-5.01a of the Illinois Public
Aid Code.
(6) Facilities established and operating under the
Alternative Health Care Delivery Act as a children's
community-based health care center alternative health care
model demonstration program or as an Alzheimer's Disease
Management Center alternative health care model
demonstration program.
(7) The closure of an entity or a portion of an entity
licensed under the Nursing Home Care Act, the Specialized
Mental Health Rehabilitation Act of 2013, the ID/DD
Community Care Act, or the MC/DD Act, with the exception of
facilities operated by a county or Illinois Veterans Homes,
that elect to convert, in whole or in part, to an assisted
living or shared housing establishment licensed under the
Assisted Living and Shared Housing Act and with the
exception of a facility licensed under the Specialized
Mental Health Rehabilitation Act of 2013 in connection with
a proposal to close a facility and re-establish the
facility in another location.
(8) Any change of ownership of a health care facility
that is licensed under the Nursing Home Care Act, the
Specialized Mental Health Rehabilitation Act of 2013, the
ID/DD Community Care Act, or the MC/DD Act, with the
exception of facilities operated by a county or Illinois
Veterans Homes. Changes of ownership of facilities
licensed under the Nursing Home Care Act must meet the
requirements set forth in Sections 3-101 through 3-119 of
the Nursing Home Care Act.
(9) Any project the Department of Healthcare and Family
Services certifies was approved by the Hospital
Transformation Review Committee as a project subject to the
hospital's transformation under subsection (d-5) of
Section 14-12 of the Illinois Public Aid Code, provided the
hospital shall submit the certification to the Board.
Nothing in this paragraph excludes a health care facility
from the requirements of this Act after the approved
transformation project is complete. All other requirements
under this Act continue to apply. Hospitals that are not
subject to this Act under this paragraph shall notify the
Health Facilities and Services Review Board within 30 days
of the dates that bed changes or service changes occur.
With the exception of those health care facilities
specifically included in this Section, nothing in this Act
shall be intended to include facilities operated as a part of
the practice of a physician or other licensed health care
professional, whether practicing in his individual capacity or
within the legal structure of any partnership, medical or
professional corporation, or unincorporated medical or
professional group. Further, this Act shall not apply to
physicians or other licensed health care professional's
practices where such practices are carried out in a portion of
a health care facility under contract with such health care
facility by a physician or by other licensed health care
professionals, whether practicing in his individual capacity
or within the legal structure of any partnership, medical or
professional corporation, or unincorporated medical or
professional groups, unless the entity constructs, modifies,
or establishes a health care facility as specifically defined
in this Section. This Act shall apply to construction or
modification and to establishment by such health care facility
of such contracted portion which is subject to facility
licensing requirements, irrespective of the party responsible
for such action or attendant financial obligation.
"Person" means any one or more natural persons, legal
entities, governmental bodies other than federal, or any
combination thereof.
"Consumer" means any person other than a person (a) whose
major occupation currently involves or whose official capacity
within the last 12 months has involved the providing,
administering or financing of any type of health care facility,
(b) who is engaged in health research or the teaching of
health, (c) who has a material financial interest in any
activity which involves the providing, administering or
financing of any type of health care facility, or (d) who is or
ever has been a member of the immediate family of the person
defined by (a), (b), or (c).
"State Board" or "Board" means the Health Facilities and
Services Review Board.
"Construction or modification" means the establishment,
erection, building, alteration, reconstruction, modernization,
improvement, extension, discontinuation, change of ownership,
of or by a health care facility, or the purchase or acquisition
by or through a health care facility of equipment or service
for diagnostic or therapeutic purposes or for facility
administration or operation, or any capital expenditure made by
or on behalf of a health care facility which exceeds the
capital expenditure minimum; however, any capital expenditure
made by or on behalf of a health care facility for (i) the
construction or modification of a facility licensed under the
Assisted Living and Shared Housing Act or (ii) a conversion
project undertaken in accordance with Section 30 of the Older
Adult Services Act shall be excluded from any obligations under
this Act.
"Establish" means the construction of a health care
facility or the replacement of an existing facility on another
site or the initiation of a category of service.
"Major medical equipment" means medical equipment which is
used for the provision of medical and other health services and
which costs in excess of the capital expenditure minimum,
except that such term does not include medical equipment
acquired by or on behalf of a clinical laboratory to provide
clinical laboratory services if the clinical laboratory is
independent of a physician's office and a hospital and it has
been determined under Title XVIII of the Social Security Act to
meet the requirements of paragraphs (10) and (11) of Section
1861(s) of such Act. In determining whether medical equipment
has a value in excess of the capital expenditure minimum, the
value of studies, surveys, designs, plans, working drawings,
specifications, and other activities essential to the
acquisition of such equipment shall be included.
"Capital Expenditure" means an expenditure: (A) made by or
on behalf of a health care facility (as such a facility is
defined in this Act); and (B) which under generally accepted
accounting principles is not properly chargeable as an expense
of operation and maintenance, or is made to obtain by lease or
comparable arrangement any facility or part thereof or any
equipment for a facility or part; and which exceeds the capital
expenditure minimum.
For the purpose of this paragraph, the cost of any studies,
surveys, designs, plans, working drawings, specifications, and
other activities essential to the acquisition, improvement,
expansion, or replacement of any plant or equipment with
respect to which an expenditure is made shall be included in
determining if such expenditure exceeds the capital
expenditures minimum. Unless otherwise interdependent, or
submitted as one project by the applicant, components of
construction or modification undertaken by means of a single
construction contract or financed through the issuance of a
single debt instrument shall not be grouped together as one
project. Donations of equipment or facilities to a health care
facility which if acquired directly by such facility would be
subject to review under this Act shall be considered capital
expenditures, and a transfer of equipment or facilities for
less than fair market value shall be considered a capital
expenditure for purposes of this Act if a transfer of the
equipment or facilities at fair market value would be subject
to review.
"Capital expenditure minimum" means $11,500,000 for
projects by hospital applicants, $6,500,000 for applicants for
projects related to skilled and intermediate care long-term
care facilities licensed under the Nursing Home Care Act, and
$3,000,000 for projects by all other applicants, which shall be
annually adjusted to reflect the increase in construction costs
due to inflation, for major medical equipment and for all other
capital expenditures.
"Non-clinical service area" means an area (i) for the
benefit of the patients, visitors, staff, or employees of a
health care facility and (ii) not directly related to the
diagnosis, treatment, or rehabilitation of persons receiving
services from the health care facility. "Non-clinical service
areas" include, but are not limited to, chapels; gift shops;
news stands; computer systems; tunnels, walkways, and
elevators; telephone systems; projects to comply with life
safety codes; educational facilities; student housing;
patient, employee, staff, and visitor dining areas;
administration and volunteer offices; modernization of
structural components (such as roof replacement and masonry
work); boiler repair or replacement; vehicle maintenance and
storage facilities; parking facilities; mechanical systems for
heating, ventilation, and air conditioning; loading docks; and
repair or replacement of carpeting, tile, wall coverings,
window coverings or treatments, or furniture. Solely for the
purpose of this definition, "non-clinical service area" does
not include health and fitness centers.
"Areawide" means a major area of the State delineated on a
geographic, demographic, and functional basis for health
planning and for health service and having within it one or
more local areas for health planning and health service. The
term "region", as contrasted with the term "subregion", and the
word "area" may be used synonymously with the term "areawide".
"Local" means a subarea of a delineated major area that on
a geographic, demographic, and functional basis may be
considered to be part of such major area. The term "subregion"
may be used synonymously with the term "local".
"Physician" means a person licensed to practice in
accordance with the Medical Practice Act of 1987, as amended.
"Licensed health care professional" means a person
licensed to practice a health profession under pertinent
licensing statutes of the State of Illinois.
"Director" means the Director of the Illinois Department of
Public Health.
"Agency" or "Department" means the Illinois Department of
Public Health.
"Alternative health care model" means a facility or program
authorized under the Alternative Health Care Delivery Act.
"Out-of-state facility" means a person that is both (i)
licensed as a hospital or as an ambulatory surgery center under
the laws of another state or that qualifies as a hospital or an
ambulatory surgery center under regulations adopted pursuant
to the Social Security Act and (ii) not licensed under the
Ambulatory Surgical Treatment Center Act, the Hospital
Licensing Act, or the Nursing Home Care Act. Affiliates of
out-of-state facilities shall be considered out-of-state
facilities. Affiliates of Illinois licensed health care
facilities 100% owned by an Illinois licensed health care
facility, its parent, or Illinois physicians licensed to
practice medicine in all its branches shall not be considered
out-of-state facilities. Nothing in this definition shall be
construed to include an office or any part of an office of a
physician licensed to practice medicine in all its branches in
Illinois that is not required to be licensed under the
Ambulatory Surgical Treatment Center Act.
"Change of ownership of a health care facility" means a
change in the person who has ownership or control of a health
care facility's physical plant and capital assets. A change in
ownership is indicated by the following transactions: sale,
transfer, acquisition, lease, change of sponsorship, or other
means of transferring control.
"Related person" means any person that: (i) is at least 50%
owned, directly or indirectly, by either the health care
facility or a person owning, directly or indirectly, at least
50% of the health care facility; or (ii) owns, directly or
indirectly, at least 50% of the health care facility.
"Charity care" means care provided by a health care
facility for which the provider does not expect to receive
payment from the patient or a third-party payer.
"Freestanding emergency center" means a facility subject
to licensure under Section 32.5 of the Emergency Medical
Services (EMS) Systems Act.
"Category of service" means a grouping by generic class of
various types or levels of support functions, equipment, care,
or treatment provided to patients or residents, including, but
not limited to, classes such as medical-surgical, pediatrics,
or cardiac catheterization. A category of service may include
subcategories or levels of care that identify a particular
degree or type of care within the category of service. Nothing
in this definition shall be construed to include the practice
of a physician or other licensed health care professional while
functioning in an office providing for the care, diagnosis, or
treatment of patients. A category of service that is subject to
the Board's jurisdiction must be designated in rules adopted by
the Board.
"State Board Staff Report" means the document that sets
forth the review and findings of the State Board staff, as
prescribed by the State Board, regarding applications subject
to Board jurisdiction.
(Source: P.A. 98-414, eff. 1-1-14; 98-629, eff. 1-1-15; 98-651,
eff. 6-16-14; 98-1086, eff. 8-26-14; 99-78, eff. 7-20-15;
99-180, eff. 7-29-15; 99-527, eff. 1-1-17.)
(Text of Section after amendment by P.A. 100-518)
(Section scheduled to be repealed on December 31, 2019)
Sec. 3. Definitions. As used in this Act:
"Health care facilities" means and includes the following
facilities, organizations, and related persons:
(1) An ambulatory surgical treatment center required
to be licensed pursuant to the Ambulatory Surgical
Treatment Center Act.
(2) An institution, place, building, or agency
required to be licensed pursuant to the Hospital Licensing
Act.
(3) Skilled and intermediate long term care facilities
licensed under the Nursing Home Care Act.
(A) If a demonstration project under the Nursing
Home Care Act applies for a certificate of need to
convert to a nursing facility, it shall meet the
licensure and certificate of need requirements in
effect as of the date of application.
(B) Except as provided in item (A) of this
subsection, this Act does not apply to facilities
granted waivers under Section 3-102.2 of the Nursing
Home Care Act.
(3.5) Skilled and intermediate care facilities
licensed under the ID/DD Community Care Act or the MC/DD
Act. No permit or exemption is required for a facility
licensed under the ID/DD Community Care Act or the MC/DD
Act prior to the reduction of the number of beds at a
facility. If there is a total reduction of beds at a
facility licensed under the ID/DD Community Care Act or the
MC/DD Act, this is a discontinuation or closure of the
facility. If a facility licensed under the ID/DD Community
Care Act or the MC/DD Act reduces the number of beds or
discontinues the facility, that facility must notify the
Board as provided in Section 14.1 of this Act.
(3.7) Facilities licensed under the Specialized Mental
Health Rehabilitation Act of 2013.
(4) Hospitals, nursing homes, ambulatory surgical
treatment centers, or kidney disease treatment centers
maintained by the State or any department or agency
thereof.
(5) Kidney disease treatment centers, including a
free-standing hemodialysis unit required to be licensed
under the End Stage Renal Disease Facility Act.
(A) This Act does not apply to a dialysis facility
that provides only dialysis training, support, and
related services to individuals with end stage renal
disease who have elected to receive home dialysis.
(B) This Act does not apply to a dialysis unit
located in a licensed nursing home that offers or
provides dialysis-related services to residents with
end stage renal disease who have elected to receive
home dialysis within the nursing home.
(C) The Board, however, may require dialysis
facilities and licensed nursing homes under items (A)
and (B) of this subsection to report statistical
information on a quarterly basis to the Board to be
used by the Board to conduct analyses on the need for
proposed kidney disease treatment centers.
(6) An institution, place, building, or room used for
the performance of outpatient surgical procedures that is
leased, owned, or operated by or on behalf of an
out-of-state facility.
(7) An institution, place, building, or room used for
provision of a health care category of service, including,
but not limited to, cardiac catheterization and open heart
surgery.
(8) An institution, place, building, or room housing
major medical equipment used in the direct clinical
diagnosis or treatment of patients, and whose project cost
is in excess of the capital expenditure minimum.
"Health care facilities" does not include the following
entities or facility transactions:
(1) Federally-owned facilities.
(2) Facilities used solely for healing by prayer or
spiritual means.
(3) An existing facility located on any campus facility
as defined in Section 5-5.8b of the Illinois Public Aid
Code, provided that the campus facility encompasses 30 or
more contiguous acres and that the new or renovated
facility is intended for use by a licensed residential
facility.
(4) Facilities licensed under the Supportive
Residences Licensing Act or the Assisted Living and Shared
Housing Act.
(5) Facilities designated as supportive living
facilities that are in good standing with the program
established under Section 5-5.01a of the Illinois Public
Aid Code.
(6) Facilities established and operating under the
Alternative Health Care Delivery Act as a children's
community-based health care center alternative health care
model demonstration program or as an Alzheimer's Disease
Management Center alternative health care model
demonstration program.
(7) The closure of an entity or a portion of an entity
licensed under the Nursing Home Care Act, the Specialized
Mental Health Rehabilitation Act of 2013, the ID/DD
Community Care Act, or the MC/DD Act, with the exception of
facilities operated by a county or Illinois Veterans Homes,
that elect to convert, in whole or in part, to an assisted
living or shared housing establishment licensed under the
Assisted Living and Shared Housing Act and with the
exception of a facility licensed under the Specialized
Mental Health Rehabilitation Act of 2013 in connection with
a proposal to close a facility and re-establish the
facility in another location.
(8) Any change of ownership of a health care facility
that is licensed under the Nursing Home Care Act, the
Specialized Mental Health Rehabilitation Act of 2013, the
ID/DD Community Care Act, or the MC/DD Act, with the
exception of facilities operated by a county or Illinois
Veterans Homes. Changes of ownership of facilities
licensed under the Nursing Home Care Act must meet the
requirements set forth in Sections 3-101 through 3-119 of
the Nursing Home Care Act.
(9) Any project the Department of Healthcare and Family
Services certifies was approved by the Hospital
Transformation Review Committee as a project subject to the
hospital's transformation under subsection (d-5) of
Section 14-12 of the Illinois Public Aid Code, provided the
hospital shall submit the certification to the Board.
Nothing in this paragraph excludes a health care facility
from the requirements of this Act after the approved
transformation project is complete. All other requirements
under this Act continue to apply. Hospitals that are not
subject to this Act under this paragraph shall notify the
Health Facilities and Services Review Board within 30 days
of the dates that bed changes or service changes occur.
With the exception of those health care facilities
specifically included in this Section, nothing in this Act
shall be intended to include facilities operated as a part of
the practice of a physician or other licensed health care
professional, whether practicing in his individual capacity or
within the legal structure of any partnership, medical or
professional corporation, or unincorporated medical or
professional group. Further, this Act shall not apply to
physicians or other licensed health care professional's
practices where such practices are carried out in a portion of
a health care facility under contract with such health care
facility by a physician or by other licensed health care
professionals, whether practicing in his individual capacity
or within the legal structure of any partnership, medical or
professional corporation, or unincorporated medical or
professional groups, unless the entity constructs, modifies,
or establishes a health care facility as specifically defined
in this Section. This Act shall apply to construction or
modification and to establishment by such health care facility
of such contracted portion which is subject to facility
licensing requirements, irrespective of the party responsible
for such action or attendant financial obligation.
"Person" means any one or more natural persons, legal
entities, governmental bodies other than federal, or any
combination thereof.
"Consumer" means any person other than a person (a) whose
major occupation currently involves or whose official capacity
within the last 12 months has involved the providing,
administering or financing of any type of health care facility,
(b) who is engaged in health research or the teaching of
health, (c) who has a material financial interest in any
activity which involves the providing, administering or
financing of any type of health care facility, or (d) who is or
ever has been a member of the immediate family of the person
defined by (a), (b), or (c).
"State Board" or "Board" means the Health Facilities and
Services Review Board.
"Construction or modification" means the establishment,
erection, building, alteration, reconstruction, modernization,
improvement, extension, discontinuation, change of ownership,
of or by a health care facility, or the purchase or acquisition
by or through a health care facility of equipment or service
for diagnostic or therapeutic purposes or for facility
administration or operation, or any capital expenditure made by
or on behalf of a health care facility which exceeds the
capital expenditure minimum; however, any capital expenditure
made by or on behalf of a health care facility for (i) the
construction or modification of a facility licensed under the
Assisted Living and Shared Housing Act or (ii) a conversion
project undertaken in accordance with Section 30 of the Older
Adult Services Act shall be excluded from any obligations under
this Act.
"Establish" means the construction of a health care
facility or the replacement of an existing facility on another
site or the initiation of a category of service.
"Major medical equipment" means medical equipment which is
used for the provision of medical and other health services and
which costs in excess of the capital expenditure minimum,
except that such term does not include medical equipment
acquired by or on behalf of a clinical laboratory to provide
clinical laboratory services if the clinical laboratory is
independent of a physician's office and a hospital and it has
been determined under Title XVIII of the Social Security Act to
meet the requirements of paragraphs (10) and (11) of Section
1861(s) of such Act. In determining whether medical equipment
has a value in excess of the capital expenditure minimum, the
value of studies, surveys, designs, plans, working drawings,
specifications, and other activities essential to the
acquisition of such equipment shall be included.
"Capital Expenditure" means an expenditure: (A) made by or
on behalf of a health care facility (as such a facility is
defined in this Act); and (B) which under generally accepted
accounting principles is not properly chargeable as an expense
of operation and maintenance, or is made to obtain by lease or
comparable arrangement any facility or part thereof or any
equipment for a facility or part; and which exceeds the capital
expenditure minimum.
For the purpose of this paragraph, the cost of any studies,
surveys, designs, plans, working drawings, specifications, and
other activities essential to the acquisition, improvement,
expansion, or replacement of any plant or equipment with
respect to which an expenditure is made shall be included in
determining if such expenditure exceeds the capital
expenditures minimum. Unless otherwise interdependent, or
submitted as one project by the applicant, components of
construction or modification undertaken by means of a single
construction contract or financed through the issuance of a
single debt instrument shall not be grouped together as one
project. Donations of equipment or facilities to a health care
facility which if acquired directly by such facility would be
subject to review under this Act shall be considered capital
expenditures, and a transfer of equipment or facilities for
less than fair market value shall be considered a capital
expenditure for purposes of this Act if a transfer of the
equipment or facilities at fair market value would be subject
to review.
"Capital expenditure minimum" means $11,500,000 for
projects by hospital applicants, $6,500,000 for applicants for
projects related to skilled and intermediate care long-term
care facilities licensed under the Nursing Home Care Act, and
$3,000,000 for projects by all other applicants, which shall be
annually adjusted to reflect the increase in construction costs
due to inflation, for major medical equipment and for all other
capital expenditures.
"Financial Commitment" means the commitment of at least 33%
of total funds assigned to cover total project cost, which
occurs by the actual expenditure of 33% or more of the total
project cost or the commitment to expend 33% or more of the
total project cost by signed contracts or other legal means.
"Non-clinical service area" means an area (i) for the
benefit of the patients, visitors, staff, or employees of a
health care facility and (ii) not directly related to the
diagnosis, treatment, or rehabilitation of persons receiving
services from the health care facility. "Non-clinical service
areas" include, but are not limited to, chapels; gift shops;
news stands; computer systems; tunnels, walkways, and
elevators; telephone systems; projects to comply with life
safety codes; educational facilities; student housing;
patient, employee, staff, and visitor dining areas;
administration and volunteer offices; modernization of
structural components (such as roof replacement and masonry
work); boiler repair or replacement; vehicle maintenance and
storage facilities; parking facilities; mechanical systems for
heating, ventilation, and air conditioning; loading docks; and
repair or replacement of carpeting, tile, wall coverings,
window coverings or treatments, or furniture. Solely for the
purpose of this definition, "non-clinical service area" does
not include health and fitness centers.
"Areawide" means a major area of the State delineated on a
geographic, demographic, and functional basis for health
planning and for health service and having within it one or
more local areas for health planning and health service. The
term "region", as contrasted with the term "subregion", and the
word "area" may be used synonymously with the term "areawide".
"Local" means a subarea of a delineated major area that on
a geographic, demographic, and functional basis may be
considered to be part of such major area. The term "subregion"
may be used synonymously with the term "local".
"Physician" means a person licensed to practice in
accordance with the Medical Practice Act of 1987, as amended.
"Licensed health care professional" means a person
licensed to practice a health profession under pertinent
licensing statutes of the State of Illinois.
"Director" means the Director of the Illinois Department of
Public Health.
"Agency" or "Department" means the Illinois Department of
Public Health.
"Alternative health care model" means a facility or program
authorized under the Alternative Health Care Delivery Act.
"Out-of-state facility" means a person that is both (i)
licensed as a hospital or as an ambulatory surgery center under
the laws of another state or that qualifies as a hospital or an
ambulatory surgery center under regulations adopted pursuant
to the Social Security Act and (ii) not licensed under the
Ambulatory Surgical Treatment Center Act, the Hospital
Licensing Act, or the Nursing Home Care Act. Affiliates of
out-of-state facilities shall be considered out-of-state
facilities. Affiliates of Illinois licensed health care
facilities 100% owned by an Illinois licensed health care
facility, its parent, or Illinois physicians licensed to
practice medicine in all its branches shall not be considered
out-of-state facilities. Nothing in this definition shall be
construed to include an office or any part of an office of a
physician licensed to practice medicine in all its branches in
Illinois that is not required to be licensed under the
Ambulatory Surgical Treatment Center Act.
"Change of ownership of a health care facility" means a
change in the person who has ownership or control of a health
care facility's physical plant and capital assets. A change in
ownership is indicated by the following transactions: sale,
transfer, acquisition, lease, change of sponsorship, or other
means of transferring control.
"Related person" means any person that: (i) is at least 50%
owned, directly or indirectly, by either the health care
facility or a person owning, directly or indirectly, at least
50% of the health care facility; or (ii) owns, directly or
indirectly, at least 50% of the health care facility.
"Charity care" means care provided by a health care
facility for which the provider does not expect to receive
payment from the patient or a third-party payer.
"Freestanding emergency center" means a facility subject
to licensure under Section 32.5 of the Emergency Medical
Services (EMS) Systems Act.
"Category of service" means a grouping by generic class of
various types or levels of support functions, equipment, care,
or treatment provided to patients or residents, including, but
not limited to, classes such as medical-surgical, pediatrics,
or cardiac catheterization. A category of service may include
subcategories or levels of care that identify a particular
degree or type of care within the category of service. Nothing
in this definition shall be construed to include the practice
of a physician or other licensed health care professional while
functioning in an office providing for the care, diagnosis, or
treatment of patients. A category of service that is subject to
the Board's jurisdiction must be designated in rules adopted by
the Board.
"State Board Staff Report" means the document that sets
forth the review and findings of the State Board staff, as
prescribed by the State Board, regarding applications subject
to Board jurisdiction.
(Source: P.A. 99-78, eff. 7-20-15; 99-180, eff. 7-29-15;
99-527, eff. 1-1-17; 100-518, eff. 6-1-18.)
Section 10. The Emergency Medical Services (EMS) Systems
Act is amended by changing Section 32.5 as follows:
(210 ILCS 50/32.5)
Sec. 32.5. Freestanding Emergency Center.
(a) The Department shall issue an annual Freestanding
Emergency Center (FEC) license to any facility that has
received a permit from the Health Facilities and Services
Review Board to establish a Freestanding Emergency Center by
January 1, 2015, and:
(1) is located: (A) in a municipality with a population
of 50,000 or fewer inhabitants; (B) within 50 miles of the
hospital that owns or controls the FEC; and (C) within 50
miles of the Resource Hospital affiliated with the FEC as
part of the EMS System;
(2) is wholly owned or controlled by an Associate or
Resource Hospital, but is not a part of the hospital's
physical plant;
(3) meets the standards for licensed FECs, adopted by
rule of the Department, including, but not limited to:
(A) facility design, specification, operation, and
maintenance standards;
(B) equipment standards; and
(C) the number and qualifications of emergency
medical personnel and other staff, which must include
at least one board certified emergency physician
present at the FEC 24 hours per day.
(4) limits its participation in the EMS System strictly
to receiving a limited number of patients by ambulance: (A)
according to the FEC's 24-hour capabilities; (B) according
to protocols developed by the Resource Hospital within the
FEC's designated EMS System; and (C) as pre-approved by
both the EMS Medical Director and the Department;
(5) provides comprehensive emergency treatment
services, as defined in the rules adopted by the Department
pursuant to the Hospital Licensing Act, 24 hours per day,
on an outpatient basis;
(6) provides an ambulance and maintains on site
ambulance services staffed with paramedics 24 hours per
day;
(7) (blank);
(8) complies with all State and federal patient rights
provisions, including, but not limited to, the Emergency
Medical Treatment Act and the federal Emergency Medical
Treatment and Active Labor Act;
(9) maintains a communications system that is fully
integrated with its Resource Hospital within the FEC's
designated EMS System;
(10) reports to the Department any patient transfers
from the FEC to a hospital within 48 hours of the transfer
plus any other data determined to be relevant by the
Department;
(11) submits to the Department, on a quarterly basis,
the FEC's morbidity and mortality rates for patients
treated at the FEC and other data determined to be relevant
by the Department;
(12) does not describe itself or hold itself out to the
general public as a full service hospital or hospital
emergency department in its advertising or marketing
activities;
(13) complies with any other rules adopted by the
Department under this Act that relate to FECs;
(14) passes the Department's site inspection for
compliance with the FEC requirements of this Act;
(15) submits a copy of the permit issued by the Health
Facilities and Services Review Board indicating that the
facility has complied with the Illinois Health Facilities
Planning Act with respect to the health services to be
provided at the facility;
(16) submits an application for designation as an FEC
in a manner and form prescribed by the Department by rule;
and
(17) pays the annual license fee as determined by the
Department by rule.
(a-5) Notwithstanding any other provision of this Section,
the Department may issue an annual FEC license to a facility
that is located in a county that does not have a licensed
general acute care hospital if the facility's application for a
permit from the Illinois Health Facilities Planning Board has
been deemed complete by the Department of Public Health by
January 1, 2014 and if the facility complies with the
requirements set forth in paragraphs (1) through (17) of
subsection (a).
(a-10) Notwithstanding any other provision of this
Section, the Department may issue an annual FEC license to a
facility if the facility has, by January 1, 2014, filed a
letter of intent to establish an FEC and if the facility
complies with the requirements set forth in paragraphs (1)
through (17) of subsection (a).
(a-15) Notwithstanding any other provision of this
Section, the Department shall issue an annual FEC license to a
facility if the facility: (i) discontinues operation as a
hospital within 180 days after the effective date of this
amendatory Act of the 99th General Assembly with a Health
Facilities and Services Review Board project number of
E-017-15; (ii) has an application for a permit to establish an
FEC from the Health Facilities and Services Review Board that
is deemed complete by January 1, 2017; and (iii) complies with
the requirements set forth in paragraphs (1) through (17) of
subsection (a) of this Section.
(a20) Notwithstanding any other provision of this
Section, the Department shall issue an annual FEC license to a
facility if:
(1) the facility is a hospital that has discontinued
inpatient hospital services;
(2) the Department of Healthcare and Family Services
has certified the conversion to an FEC was approved by the
Hospital Transformation Review Committee as a project
subject to the hospital's transformation under subsection
(d-5) of Section 14-12 of the Illinois Public Aid Code;
(3) the facility complies with the requirements set
forth in paragraphs (1) through (17), provided however that
the FEC may be located in a municipality with a population
greater than 50,000 inhabitants and shall not be subject to
the requirements of the Illinois Health Facilities
Planning Act that are applicable to the conversion to an
FEC if the Department of Healthcare and Family Service has
certified the conversion to an FEC was approved by the
Hospital Transformation Review Committee as a project
subject to the hospital's transformation under subsection
(d-5) of Section 14-12 of the Illinois Public Aid Code; and
(4) the facility is located at the same physical
location where the facility served as a hospital.
(b) The Department shall:
(1) annually inspect facilities of initial FEC
applicants and licensed FECs, and issue annual licenses to
or annually relicense FECs that satisfy the Department's
licensure requirements as set forth in subsection (a);
(2) suspend, revoke, refuse to issue, or refuse to
renew the license of any FEC, after notice and an
opportunity for a hearing, when the Department finds that
the FEC has failed to comply with the standards and
requirements of the Act or rules adopted by the Department
under the Act;
(3) issue an Emergency Suspension Order for any FEC
when the Director or his or her designee has determined
that the continued operation of the FEC poses an immediate
and serious danger to the public health, safety, and
welfare. An opportunity for a hearing shall be promptly
initiated after an Emergency Suspension Order has been
issued; and
(4) adopt rules as needed to implement this Section.
(Source: P.A. 99-490, eff. 12-4-15; 99-710, eff. 8-5-16.)
Section 15. The Illinois Public Aid Code is amended by
changing Sections 5-5.02, 5-5e.1, 5A-2, 5A-4, 5A-5, 5A-8,
5A-10, 5A-12.5, 5A-13, 5A-14, 5A-15, 12-4.105, and 14-12, and
by adding Sections 5A-12.6, and 5A-16 as follows:
(305 ILCS 5/5-5.02) (from Ch. 23, par. 5-5.02)
Sec. 5-5.02. Hospital reimbursements.
(a) Reimbursement to Hospitals; July 1, 1992 through
September 30, 1992. Notwithstanding any other provisions of
this Code or the Illinois Department's Rules promulgated under
the Illinois Administrative Procedure Act, reimbursement to
hospitals for services provided during the period July 1, 1992
through September 30, 1992, shall be as follows:
(1) For inpatient hospital services rendered, or if
applicable, for inpatient hospital discharges occurring,
on or after July 1, 1992 and on or before September 30,
1992, the Illinois Department shall reimburse hospitals
for inpatient services under the reimbursement
methodologies in effect for each hospital, and at the
inpatient payment rate calculated for each hospital, as of
June 30, 1992. For purposes of this paragraph,
"reimbursement methodologies" means all reimbursement
methodologies that pertain to the provision of inpatient
hospital services, including, but not limited to, any
adjustments for disproportionate share, targeted access,
critical care access and uncompensated care, as defined by
the Illinois Department on June 30, 1992.
(2) For the purpose of calculating the inpatient
payment rate for each hospital eligible to receive
quarterly adjustment payments for targeted access and
critical care, as defined by the Illinois Department on
June 30, 1992, the adjustment payment for the period July
1, 1992 through September 30, 1992, shall be 25% of the
annual adjustment payments calculated for each eligible
hospital, as of June 30, 1992. The Illinois Department
shall determine by rule the adjustment payments for
targeted access and critical care beginning October 1,
1992.
(3) For the purpose of calculating the inpatient
payment rate for each hospital eligible to receive
quarterly adjustment payments for uncompensated care, as
defined by the Illinois Department on June 30, 1992, the
adjustment payment for the period August 1, 1992 through
September 30, 1992, shall be one-sixth of the total
uncompensated care adjustment payments calculated for each
eligible hospital for the uncompensated care rate year, as
defined by the Illinois Department, ending on July 31,
1992. The Illinois Department shall determine by rule the
adjustment payments for uncompensated care beginning
October 1, 1992.
(b) Inpatient payments. For inpatient services provided on
or after October 1, 1993, in addition to rates paid for
hospital inpatient services pursuant to the Illinois Health
Finance Reform Act, as now or hereafter amended, or the
Illinois Department's prospective reimbursement methodology,
or any other methodology used by the Illinois Department for
inpatient services, the Illinois Department shall make
adjustment payments, in an amount calculated pursuant to the
methodology described in paragraph (c) of this Section, to
hospitals that the Illinois Department determines satisfy any
one of the following requirements:
(1) Hospitals that are described in Section 1923 of the
federal Social Security Act, as now or hereafter amended,
except that for rate year 2015 and after a hospital
described in Section 1923(b)(1)(B) of the federal Social
Security Act and qualified for the payments described in
subsection (c) of this Section for rate year 2014 provided
the hospital continues to meet the description in Section
1923(b)(1)(B) in the current determination year; or
(2) Illinois hospitals that have a Medicaid inpatient
utilization rate which is at least one-half a standard
deviation above the mean Medicaid inpatient utilization
rate for all hospitals in Illinois receiving Medicaid
payments from the Illinois Department; or
(3) Illinois hospitals that on July 1, 1991 had a
Medicaid inpatient utilization rate, as defined in
paragraph (h) of this Section, that was at least the mean
Medicaid inpatient utilization rate for all hospitals in
Illinois receiving Medicaid payments from the Illinois
Department and which were located in a planning area with
one-third or fewer excess beds as determined by the Health
Facilities and Services Review Board, and that, as of June
30, 1992, were located in a federally designated Health
Manpower Shortage Area; or
(4) Illinois hospitals that:
(A) have a Medicaid inpatient utilization rate
that is at least equal to the mean Medicaid inpatient
utilization rate for all hospitals in Illinois
receiving Medicaid payments from the Department; and
(B) also have a Medicaid obstetrical inpatient
utilization rate that is at least one standard
deviation above the mean Medicaid obstetrical
inpatient utilization rate for all hospitals in
Illinois receiving Medicaid payments from the
Department for obstetrical services; or
(5) Any children's hospital, which means a hospital
devoted exclusively to caring for children. A hospital
which includes a facility devoted exclusively to caring for
children shall be considered a children's hospital to the
degree that the hospital's Medicaid care is provided to
children if either (i) the facility devoted exclusively to
caring for children is separately licensed as a hospital by
a municipality prior to February 28, 2013 or (ii) the
hospital has been designated by the State as a Level III
perinatal care facility, has a Medicaid Inpatient
Utilization rate greater than 55% for the rate year 2003
disproportionate share determination, and has more than
10,000 qualified children days as defined by the Department
in rulemaking.
(c) Inpatient adjustment payments. The adjustment payments
required by paragraph (b) shall be calculated based upon the
hospital's Medicaid inpatient utilization rate as follows:
(1) hospitals with a Medicaid inpatient utilization
rate below the mean shall receive a per day adjustment
payment equal to $25;
(2) hospitals with a Medicaid inpatient utilization
rate that is equal to or greater than the mean Medicaid
inpatient utilization rate but less than one standard
deviation above the mean Medicaid inpatient utilization
rate shall receive a per day adjustment payment equal to
the sum of $25 plus $1 for each one percent that the
hospital's Medicaid inpatient utilization rate exceeds the
mean Medicaid inpatient utilization rate;
(3) hospitals with a Medicaid inpatient utilization
rate that is equal to or greater than one standard
deviation above the mean Medicaid inpatient utilization
rate but less than 1.5 standard deviations above the mean
Medicaid inpatient utilization rate shall receive a per day
adjustment payment equal to the sum of $40 plus $7 for each
one percent that the hospital's Medicaid inpatient
utilization rate exceeds one standard deviation above the
mean Medicaid inpatient utilization rate; and
(4) hospitals with a Medicaid inpatient utilization
rate that is equal to or greater than 1.5 standard
deviations above the mean Medicaid inpatient utilization
rate shall receive a per day adjustment payment equal to
the sum of $90 plus $2 for each one percent that the
hospital's Medicaid inpatient utilization rate exceeds 1.5
standard deviations above the mean Medicaid inpatient
utilization rate.
(d) Supplemental adjustment payments. In addition to the
adjustment payments described in paragraph (c), hospitals as
defined in clauses (1) through (5) of paragraph (b), excluding
county hospitals (as defined in subsection (c) of Section 15-1
of this Code) and a hospital organized under the University of
Illinois Hospital Act, shall be paid supplemental inpatient
adjustment payments of $60 per day. For purposes of Title XIX
of the federal Social Security Act, these supplemental
adjustment payments shall not be classified as adjustment
payments to disproportionate share hospitals.
(e) The inpatient adjustment payments described in
paragraphs (c) and (d) shall be increased on October 1, 1993
and annually thereafter by a percentage equal to the lesser of
(i) the increase in the DRI hospital cost index for the most
recent 12 month period for which data are available, or (ii)
the percentage increase in the statewide average hospital
payment rate over the previous year's statewide average
hospital payment rate. The sum of the inpatient adjustment
payments under paragraphs (c) and (d) to a hospital, other than
a county hospital (as defined in subsection (c) of Section 15-1
of this Code) or a hospital organized under the University of
Illinois Hospital Act, however, shall not exceed $275 per day;
that limit shall be increased on October 1, 1993 and annually
thereafter by a percentage equal to the lesser of (i) the
increase in the DRI hospital cost index for the most recent
12-month period for which data are available or (ii) the
percentage increase in the statewide average hospital payment
rate over the previous year's statewide average hospital
payment rate.
(f) Children's hospital inpatient adjustment payments. For
children's hospitals, as defined in clause (5) of paragraph
(b), the adjustment payments required pursuant to paragraphs
(c) and (d) shall be multiplied by 2.0.
(g) County hospital inpatient adjustment payments. For
county hospitals, as defined in subsection (c) of Section 15-1
of this Code, there shall be an adjustment payment as
determined by rules issued by the Illinois Department.
(h) For the purposes of this Section the following terms
shall be defined as follows:
(1) "Medicaid inpatient utilization rate" means a
fraction, the numerator of which is the number of a
hospital's inpatient days provided in a given 12-month
period to patients who, for such days, were eligible for
Medicaid under Title XIX of the federal Social Security
Act, and the denominator of which is the total number of
the hospital's inpatient days in that same period.
(2) "Mean Medicaid inpatient utilization rate" means
the total number of Medicaid inpatient days provided by all
Illinois Medicaid-participating hospitals divided by the
total number of inpatient days provided by those same
hospitals.
(3) "Medicaid obstetrical inpatient utilization rate"
means the ratio of Medicaid obstetrical inpatient days to
total Medicaid inpatient days for all Illinois hospitals
receiving Medicaid payments from the Illinois Department.
(i) Inpatient adjustment payment limit. In order to meet
the limits of Public Law 102-234 and Public Law 103-66, the
Illinois Department shall by rule adjust disproportionate
share adjustment payments.
(j) University of Illinois Hospital inpatient adjustment
payments. For hospitals organized under the University of
Illinois Hospital Act, there shall be an adjustment payment as
determined by rules adopted by the Illinois Department.
(k) The Illinois Department may by rule establish criteria
for and develop methodologies for adjustment payments to
hospitals participating under this Article.
(l) On and after July 1, 2012, the Department shall reduce
any rate of reimbursement for services or other payments or
alter any methodologies authorized by this Code to reduce any
rate of reimbursement for services or other payments in
accordance with Section 5-5e.
(m) The Department shall establish a cost-based
reimbursement methodology for determining payments to
hospitals for approved graduate medical education (GME)
programs for dates of service on and after July 1, 2018.
(1) As used in this subsection, "hospitals" means the
University of Illinois Hospital as defined in the
University of Illinois Hospital Act and a county hospital
in a county of over 3,000,000 inhabitants.
(2) An amendment to the Illinois Title XIX State Plan
defining GME shall maximize reimbursement, shall not be
limited to the education programs or special patient care
payments allowed under Medicare, and shall include:
(A) inpatient days;
(B) outpatient days;
(C) direct costs;
(D) indirect costs;
(E) managed care days;
(F) all stages of medical training and education
including students, interns, residents, and fellows
with no caps on the number of persons who may qualify;
and
(G) patient care payments related to the
complexities of treating Medicaid enrollees including
clinical and social determinants of health.
(3) The Department shall make all GME payments directly
to hospitals including such costs in support of clients
enrolled in Medicaid managed care entities.
(4) The Department shall promptly take all actions
necessary for reimbursement to be effective for dates of
service on and after July 1, 2018 including publishing all
appropriate public notices, amendments to the Illinois
Title XIX State Plan, and adoption of administrative rules
if necessary.
(5) As used in this subsection, "managed care days"
means costs associated with services rendered to enrollees
of Medicaid managed care entities. "Medicaid managed care
entities" means any entity which contracts with the
Department to provide services paid for on a capitated
basis. "Medicaid managed care entities" includes a managed
care organization and a managed care community network.
(6) All payments under this Section are contingent upon
federal approval of changes to the Illinois Title XIX State
Plan, if that approval is required.
(7) The Department may adopt rules necessary to
implement this amendatory Act of the 100th General Assembly
through the use of emergency rulemaking in accordance with
subsection (aa) of Section 5-45 of the Illinois
Administrative Procedure Act. For purposes of that Act, the
General Assembly finds that the adoption of rules to
implement this amendatory Act of the 100th General Assembly
is deemed an emergency and necessary for the public
interest, safety, and welfare.
(Source: P.A. 97-689, eff. 6-14-12; 98-104, eff. 7-22-13.)
(305 ILCS 5/5-5e.1)
Sec. 5-5e.1. Safety-Net Hospitals.
(a) A Safety-Net Hospital is an Illinois hospital that:
(1) is licensed by the Department of Public Health as a
general acute care or pediatric hospital; and
(2) is a disproportionate share hospital, as described
in Section 1923 of the federal Social Security Act, as
determined by the Department; and
(3) meets one of the following:
(A) has a MIUR of at least 40% and a charity
percent of at least 4%; or
(B) has a MIUR of at least 50%.
(b) Definitions. As used in this Section:
(1) "Charity percent" means the ratio of (i) the
hospital's charity charges for services provided to
individuals without health insurance or another source of
third party coverage to (ii) the Illinois total hospital
charges, each as reported on the hospital's OBRA form.
(2) "MIUR" means Medicaid Inpatient Utilization Rate
and is defined as a fraction, the numerator of which is the
number of a hospital's inpatient days provided in the
hospital's fiscal year ending 3 years prior to the rate
year, to patients who, for such days, were eligible for
Medicaid under Title XIX of the federal Social Security
Act, 42 USC 1396a et seq., excluding those persons eligible
for medical assistance pursuant to 42 U.S.C.
1396a(a)(10)(A)(i)(VIII) as set forth in paragraph 18 of
Section 5-2 of this Article, and the denominator of which
is the total number of the hospital's inpatient days in
that same period, excluding those persons eligible for
medical assistance pursuant to 42 U.S.C.
1396a(a)(10)(A)(i)(VIII) as set forth in paragraph 18 of
Section 5-2 of this Article.
(3) "OBRA form" means form HFS-3834, OBRA '93 data
collection form, for the rate year.
(4) "Rate year" means the 12-month period beginning on
October 1.
(c) Beginning July 1, 2012 and ending on June 30, 2020
2018, a hospital that would have qualified for the rate year
beginning October 1, 2011, shall be a Safety-Net Hospital.
(d) No later than August 15 preceding the rate year, each
hospital shall submit the OBRA form to the Department. Prior to
October 1, the Department shall notify each hospital whether it
has qualified as a Safety-Net Hospital.
(e) The Department may promulgate rules in order to
implement this Section.
(f) Nothing in this Section shall be construed as limiting
the ability of the Department to include the Safety-Net
Hospitals in the hospital rate reform mandated by Section 14-11
of this Code and implemented under Section 14-12 of this Code
and by administrative rulemaking.
(Source: P.A. 97-689, eff. 6-14-12; 98-104, eff. 7-22-13;
98-651, eff. 6-16-14.)
(305 ILCS 5/5A-2) (from Ch. 23, par. 5A-2)
(Section scheduled to be repealed on July 1, 2018)
Sec. 5A-2. Assessment.
(a)(1) Subject to Sections 5A-3 and 5A-10, for State fiscal
years 2009 through 2018, or as long as continued under Section
5A-16, an annual assessment on inpatient services is imposed on
each hospital provider in an amount equal to $218.38 multiplied
by the difference of the hospital's occupied bed days less the
hospital's Medicare bed days, provided, however, that the
amount of $218.38 shall be increased by a uniform percentage to
generate an amount equal to 75% of the State share of the
payments authorized under Section 5A-12.5, with such increase
only taking effect upon the date that a State share for such
payments is required under federal law. For the period of April
through June 2015, the amount of $218.38 used to calculate the
assessment under this paragraph shall, by emergency rule under
subsection (s) of Section 5-45 of the Illinois Administrative
Procedure Act, be increased by a uniform percentage to generate
$20,250,000 in the aggregate for that period from all hospitals
subject to the annual assessment under this paragraph.
(2) In addition to any other assessments imposed under this
Article, effective July 1, 2016 and semi-annually thereafter
through June 2018, or as provided in Section 5A-16, in addition
to any federally required State share as authorized under
paragraph (1), the amount of $218.38 shall be increased by a
uniform percentage to generate an amount equal to 75% of the
ACA Assessment Adjustment, as defined in subsection (b-6) of
this Section.
For State fiscal years 2009 through 2018 2014 and after, or
as provided in Section 5A-16, a hospital's occupied bed days
and Medicare bed days shall be determined using the most recent
data available from each hospital's 2005 Medicare cost report
as contained in the Healthcare Cost Report Information System
file, for the quarter ending on December 31, 2006, without
regard to any subsequent adjustments or changes to such data.
If a hospital's 2005 Medicare cost report is not contained in
the Healthcare Cost Report Information System, then the
Illinois Department may obtain the hospital provider's
occupied bed days and Medicare bed days from any source
available, including, but not limited to, records maintained by
the hospital provider, which may be inspected at all times
during business hours of the day by the Illinois Department or
its duly authorized agents and employees.
(3) Subject to Sections 5A-3, 5A-10, and 5A-16, for State
fiscal years 2019 and 2020, an annual assessment on inpatient
services is imposed on each hospital provider in an amount
equal to $197.19 multiplied by the difference of the hospital's
occupied bed days less the hospital's Medicare bed days;
however, for State fiscal year 2020, the amount of $197.19
shall be increased by a uniform percentage to generate an
additional $6,250,000 in the aggregate for that period from all
hospitals subject to the annual assessment under this
paragraph. For State fiscal years 2019 and 2020, a hospital's
occupied bed days and Medicare bed days shall be determined
using the most recent data available from each hospital's 2015
Medicare cost report as contained in the Healthcare Cost Report
Information System file, for the quarter ending on March 31,
2017, without regard to any subsequent adjustments or changes
to such data. If a hospital's 2015 Medicare cost report is not
contained in the Healthcare Cost Report Information System,
then the Illinois Department may obtain the hospital provider's
occupied bed days and Medicare bed days from any source
available, including, but not limited to, records maintained by
the hospital provider, which may be inspected at all times
during business hours of the day by the Illinois Department or
its duly authorized agents and employees. Notwithstanding any
other provision in this Article, for a hospital provider that
did not have a 2015 Medicare cost report, but paid an
assessment in State fiscal year 2018 on the basis of
hypothetical data, that assessment amount shall be used for
State fiscal years 2019 and 2020; however, for State fiscal
year 2020, the assessment amount shall be increased by the
proportion that it represents of the total annual assessment
that is generated from all hospitals in order to generate
$6,250,000 in the aggregate for that period from all hospitals
subject to the annual assessment under this paragraph.
Subject to Sections 5A-3 and 5A-10, for State fiscal years
2021 through 2024, an annual assessment on inpatient services
is imposed on each hospital provider in an amount equal to
$197.19 multiplied by the difference of the hospital's occupied
bed days less the hospital's Medicare bed days, provided
however, that the amount of $197.19 used to calculate the
assessment under this paragraph shall, by rule, be adjusted by
a uniform percentage to generate the same total annual
assessment that was generated in State fiscal year 2020 from
all hospitals subject to the annual assessment under this
paragraph plus $6,250,000. For State fiscal years 2021 and
2022, a hospital's occupied bed days and Medicare bed days
shall be determined using the most recent data available from
each hospital's 2017 Medicare cost report as contained in the
Healthcare Cost Report Information System file, for the quarter
ending on March 31, 2019, without regard to any subsequent
adjustments or changes to such data. For State fiscal years
2023 and 2024, a hospital's occupied bed days and Medicare bed
days shall be determined using the most recent data available
from each hospital's 2019 Medicare cost report as contained in
the Healthcare Cost Report Information System file, for the
quarter ending on March 31, 2021, without regard to any
subsequent adjustments or changes to such data.
(b) (Blank).
(b-5)(1) Subject to Sections 5A-3 and 5A-10, for the
portion of State fiscal year 2012, beginning June 10, 2012
through June 30, 2012, and for State fiscal years 2013 through
2018, or as provided in Section 5A-16, an annual assessment on
outpatient services is imposed on each hospital provider in an
amount equal to .008766 multiplied by the hospital's outpatient
gross revenue, provided, however, that the amount of .008766
shall be increased by a uniform percentage to generate an
amount equal to 25% of the State share of the payments
authorized under Section 5A-12.5, with such increase only
taking effect upon the date that a State share for such
payments is required under federal law. For the period
beginning June 10, 2012 through June 30, 2012, the annual
assessment on outpatient services shall be prorated by
multiplying the assessment amount by a fraction, the numerator
of which is 21 days and the denominator of which is 365 days.
For the period of April through June 2015, the amount of
.008766 used to calculate the assessment under this paragraph
shall, by emergency rule under subsection (s) of Section 5-45
of the Illinois Administrative Procedure Act, be increased by a
uniform percentage to generate $6,750,000 in the aggregate for
that period from all hospitals subject to the annual assessment
under this paragraph.
(2) In addition to any other assessments imposed under this
Article, effective July 1, 2016 and semi-annually thereafter
through June 2018, in addition to any federally required State
share as authorized under paragraph (1), the amount of .008766
shall be increased by a uniform percentage to generate an
amount equal to 25% of the ACA Assessment Adjustment, as
defined in subsection (b-6) of this Section.
For the portion of State fiscal year 2012, beginning June
10, 2012 through June 30, 2012, and State fiscal years 2013
through 2018, or as provided in Section 5A-16, a hospital's
outpatient gross revenue shall be determined using the most
recent data available from each hospital's 2009 Medicare cost
report as contained in the Healthcare Cost Report Information
System file, for the quarter ending on June 30, 2011, without
regard to any subsequent adjustments or changes to such data.
If a hospital's 2009 Medicare cost report is not contained in
the Healthcare Cost Report Information System, then the
Department may obtain the hospital provider's outpatient gross
revenue from any source available, including, but not limited
to, records maintained by the hospital provider, which may be
inspected at all times during business hours of the day by the
Department or its duly authorized agents and employees.
(3) Subject to Sections 5A-3, 5A-10, and 5A-16, for State
fiscal years 2019 and 2020, an annual assessment on outpatient
services is imposed on each hospital provider in an amount
equal to .01358 multiplied by the hospital's outpatient gross
revenue; however, for State fiscal year 2020, the amount of
.01358 shall be increased by a uniform percentage to generate
an additional $6,250,000 in the aggregate for that period from
all hospitals subject to the annual assessment under this
paragraph. For State fiscal years 2019 and 2020, a hospital's
outpatient gross revenue shall be determined using the most
recent data available from each hospital's 2015 Medicare cost
report as contained in the Healthcare Cost Report Information
System file, for the quarter ending on March 31, 2017, without
regard to any subsequent adjustments or changes to such data.
If a hospital's 2015 Medicare cost report is not contained in
the Healthcare Cost Report Information System, then the
Department may obtain the hospital provider's outpatient gross
revenue from any source available, including, but not limited
to, records maintained by the hospital provider, which may be
inspected at all times during business hours of the day by the
Department or its duly authorized agents and employees.
Notwithstanding any other provision in this Article, for a
hospital provider that did not have a 2015 Medicare cost
report, but paid an assessment in State fiscal year 2018 on the
basis of hypothetical data, that assessment amount shall be
used for State fiscal years 2019 and 2020; however, for State
fiscal year 2020, the assessment amount shall be increased by
the proportion that it represents of the total annual
assessment that is generated from all hospitals in order to
generate $6,250,000 in the aggregate for that period from all
hospitals subject to the annual assessment under this
paragraph.
Subject to Sections 5A-3 and 5A-10, for State fiscal years
2021 through 2024, an annual assessment on outpatient services
is imposed on each hospital provider in an amount equal to
.01358 multiplied by the hospital's outpatient gross revenue,
provided however, that the amount of .01358 used to calculate
the assessment under this paragraph shall, by rule, be adjusted
by a uniform percentage to generate the same total annual
assessment that was generated in State fiscal year 2020 from
all hospitals subject to the annual assessment under this
paragraph plus $6,250,000. For State fiscal years 2021 and
2022, a hospital's outpatient gross revenue shall be determined
using the most recent data available from each hospital's 2017
Medicare cost report as contained in the Healthcare Cost Report
Information System file, for the quarter ending on March 31,
2019, without regard to any subsequent adjustments or changes
to such data. For State fiscal years 2023 and 2024, a
hospital's outpatient gross revenue shall be determined using
the most recent data available from each hospital's 2019
Medicare cost report as contained in the Healthcare Cost Report
Information System file, for the quarter ending on March 31,
2021, without regard to any subsequent adjustments or changes
to such data.
(b-6)(1) As used in this Section, "ACA Assessment
Adjustment" means:
(A) For the period of July 1, 2016 through December 31,
2016, the product of .19125 multiplied by the sum of the
fee-for-service payments to hospitals as authorized under
Section 5A-12.5 and the adjustments authorized under
subsection (t) of Section 5A-12.2 to managed care
organizations for hospital services due and payable in the
month of April 2016 multiplied by 6.
(B) For the period of January 1, 2017 through June 30,
2017, the product of .19125 multiplied by the sum of the
fee-for-service payments to hospitals as authorized under
Section 5A-12.5 and the adjustments authorized under
subsection (t) of Section 5A-12.2 to managed care
organizations for hospital services due and payable in the
month of October 2016 multiplied by 6, except that the
amount calculated under this subparagraph (B) shall be
adjusted, either positively or negatively, to account for
the difference between the actual payments issued under
Section 5A-12.5 for the period beginning July 1, 2016
through December 31, 2016 and the estimated payments due
and payable in the month of April 2016 multiplied by 6 as
described in subparagraph (A).
(C) For the period of July 1, 2017 through December 31,
2017, the product of .19125 multiplied by the sum of the
fee-for-service payments to hospitals as authorized under
Section 5A-12.5 and the adjustments authorized under
subsection (t) of Section 5A-12.2 to managed care
organizations for hospital services due and payable in the
month of April 2017 multiplied by 6, except that the amount
calculated under this subparagraph (C) shall be adjusted,
either positively or negatively, to account for the
difference between the actual payments issued under
Section 5A-12.5 for the period beginning January 1, 2017
through June 30, 2017 and the estimated payments due and
payable in the month of October 2016 multiplied by 6 as
described in subparagraph (B).
(D) For the period of January 1, 2018 through June 30,
2018, the product of .19125 multiplied by the sum of the
fee-for-service payments to hospitals as authorized under
Section 5A-12.5 and the adjustments authorized under
subsection (t) of Section 5A-12.2 to managed care
organizations for hospital services due and payable in the
month of October 2017 multiplied by 6, except that:
(i) the amount calculated under this subparagraph
(D) shall be adjusted, either positively or
negatively, to account for the difference between the
actual payments issued under Section 5A-12.5 for the
period of July 1, 2017 through December 31, 2017 and
the estimated payments due and payable in the month of
April 2017 multiplied by 6 as described in subparagraph
(C); and
(ii) the amount calculated under this subparagraph
(D) shall be adjusted to include the product of .19125
multiplied by the sum of the fee-for-service payments,
if any, estimated to be paid to hospitals under
subsection (b) of Section 5A-12.5.
(2) The Department shall complete and apply a final
reconciliation of the ACA Assessment Adjustment prior to June
30, 2018 to account for:
(A) any differences between the actual payments issued
or scheduled to be issued prior to June 30, 2018 as
authorized in Section 5A-12.5 for the period of January 1,
2018 through June 30, 2018 and the estimated payments due
and payable in the month of October 2017 multiplied by 6 as
described in subparagraph (D); and
(B) any difference between the estimated
fee-for-service payments under subsection (b) of Section
5A-12.5 and the amount of such payments that are actually
scheduled to be paid.
The Department shall notify hospitals of any additional
amounts owed or reduction credits to be applied to the June
2018 ACA Assessment Adjustment. This is to be considered the
final reconciliation for the ACA Assessment Adjustment.
(3) Notwithstanding any other provision of this Section, if
for any reason the scheduled payments under subsection (b) of
Section 5A-12.5 are not issued in full by the final day of the
period authorized under subsection (b) of Section 5A-12.5,
funds collected from each hospital pursuant to subparagraph (D)
of paragraph (1) and pursuant to paragraph (2), attributable to
the scheduled payments authorized under subsection (b) of
Section 5A-12.5 that are not issued in full by the final day of
the period attributable to each payment authorized under
subsection (b) of Section 5A-12.5, shall be refunded.
(4) The increases authorized under paragraph (2) of
subsection (a) and paragraph (2) of subsection (b-5) shall be
limited to the federally required State share of the total
payments authorized under Section 5A-12.5 if the sum of such
payments yields an annualized amount equal to or less than
$450,000,000, or if the adjustments authorized under
subsection (t) of Section 5A-12.2 are found not to be
actuarially sound; however, this limitation shall not apply to
the fee-for-service payments described in subsection (b) of
Section 5A-12.5.
(c) (Blank).
(d) Notwithstanding any of the other provisions of this
Section, the Department is authorized to adopt rules to reduce
the rate of any annual assessment imposed under this Section,
as authorized by Section 5-46.2 of the Illinois Administrative
Procedure Act.
(e) Notwithstanding any other provision of this Section,
any plan providing for an assessment on a hospital provider as
a permissible tax under Title XIX of the federal Social
Security Act and Medicaid-eligible payments to hospital
providers from the revenues derived from that assessment shall
be reviewed by the Illinois Department of Healthcare and Family
Services, as the Single State Medicaid Agency required by
federal law, to determine whether those assessments and
hospital provider payments meet federal Medicaid standards. If
the Department determines that the elements of the plan may
meet federal Medicaid standards and a related State Medicaid
Plan Amendment is prepared in a manner and form suitable for
submission, that State Plan Amendment shall be submitted in a
timely manner for review by the Centers for Medicare and
Medicaid Services of the United States Department of Health and
Human Services and subject to approval by the Centers for
Medicare and Medicaid Services of the United States Department
of Health and Human Services. No such plan shall become
effective without approval by the Illinois General Assembly by
the enactment into law of related legislation. Notwithstanding
any other provision of this Section, the Department is
authorized to adopt rules to reduce the rate of any annual
assessment imposed under this Section. Any such rules may be
adopted by the Department under Section 5-50 of the Illinois
Administrative Procedure Act.
(Source: P.A. 98-104, eff. 7-22-13; 98-651, eff. 6-16-14; 99-2,
eff. 3-26-15; 99-516, eff. 6-30-16.)
(305 ILCS 5/5A-4) (from Ch. 23, par. 5A-4)
Sec. 5A-4. Payment of assessment; penalty.
(a) The assessment imposed by Section 5A-2 for State fiscal
year 2009 through State fiscal year 2018 or as provided in
Section 5A-16, and each subsequent State fiscal year shall be
due and payable in monthly installments, each equaling
one-twelfth of the assessment for the year, on the fourteenth
State business day of each month. No installment payment of an
assessment imposed by Section 5A-2 shall be due and payable,
however, until after the Comptroller has issued the payments
required under this Article.
Except as provided in subsection (a-5) of this Section, the
assessment imposed by subsection (b-5) of Section 5A-2 for the
portion of State fiscal year 2012 beginning June 10, 2012
through June 30, 2012, and for State fiscal year 2013 through
State fiscal year 2018 or as provided in Section 5A-16, and
each subsequent State fiscal year shall be due and payable in
monthly installments, each equaling one-twelfth of the
assessment for the year, on the 14th State business day of each
month. No installment payment of an assessment imposed by
subsection (b-5) of Section 5A-2 shall be due and payable,
however, until after: (i) the Department notifies the hospital
provider, in writing, that the payment methodologies to
hospitals required under Section 5A-12.4, have been approved by
the Centers for Medicare and Medicaid Services of the U.S.
Department of Health and Human Services, and the waiver under
42 CFR 433.68 for the assessment imposed by subsection (b-5) of
Section 5A-2, if necessary, has been granted by the Centers for
Medicare and Medicaid Services of the U.S. Department of Health
and Human Services; and (ii) the Comptroller has issued the
payments required under Section 5A-12.4. Upon notification to
the Department of approval of the payment methodologies
required under Section 5A-12.4 and the waiver granted under 42
CFR 433.68, if necessary, all installments otherwise due under
subsection (b-5) of Section 5A-2 prior to the date of
notification shall be due and payable to the Department upon
written direction from the Department and issuance by the
Comptroller of the payments required under Section 5A-12.4.
Except as provided in subsection (a-5) of this Section, the
assessment imposed under Section 5A-2 for State fiscal year
2019 and each subsequent State fiscal year shall be due and
payable in monthly installments, each equaling one-twelfth of
the assessment for the year, on the 14th State business day of
each month. No installment payment of an assessment imposed by
Section 5A-2 shall be due and payable, however, until after:
(i) the Department notifies the hospital provider, in writing,
that the payment methodologies to hospitals required under
Section 5A-12.6 have been approved by the Centers for Medicare
and Medicaid Services of the U.S. Department of Health and
Human Services, and the waiver under 42 CFR 433.68 for the
assessment imposed by Section 5A-2, if necessary, has been
granted by the Centers for Medicare and Medicaid Services of
the U.S. Department of Health and Human Services; and (ii) the
Comptroller has issued the payments required under Section
5A-12.6. Upon notification to the Department of approval of the
payment methodologies required under Section 5A-12.6 and the
waiver granted under 42 CFR 433.68, if necessary, all
installments otherwise due under Section 5A-2 prior to the date
of notification shall be due and payable to the Department upon
written direction from the Department and issuance by the
Comptroller of the payments required under Section 5A-12.6.
(a-5) The Illinois Department may accelerate the schedule
upon which assessment installments are due and payable by
hospitals with a payment ratio greater than or equal to one.
Such acceleration of due dates for payment of the assessment
may be made only in conjunction with a corresponding
acceleration in access payments identified in Section 5A-12.2,
or Section 5A-12.4, or Section 5A-12.6 to the same hospitals.
For the purposes of this subsection (a-5), a hospital's payment
ratio is defined as the quotient obtained by dividing the total
payments for the State fiscal year, as authorized under Section
5A-12.2, or Section 5A-12.4, or Section 5A-12.6, by the total
assessment for the State fiscal year imposed under Section 5A-2
or subsection (b-5) of Section 5A-2.
(b) The Illinois Department is authorized to establish
delayed payment schedules for hospital providers that are
unable to make installment payments when due under this Section
due to financial difficulties, as determined by the Illinois
Department.
(c) If a hospital provider fails to pay the full amount of
an installment when due (including any extensions granted under
subsection (b)), there shall, unless waived by the Illinois
Department for reasonable cause, be added to the assessment
imposed by Section 5A-2 a penalty assessment equal to the
lesser of (i) 5% of the amount of the installment not paid on
or before the due date plus 5% of the portion thereof remaining
unpaid on the last day of each 30-day period thereafter or (ii)
100% of the installment amount not paid on or before the due
date. For purposes of this subsection, payments will be
credited first to unpaid installment amounts (rather than to
penalty or interest), beginning with the most delinquent
installments.
(d) Any assessment amount that is due and payable to the
Illinois Department more frequently than once per calendar
quarter shall be remitted to the Illinois Department by the
hospital provider by means of electronic funds transfer. The
Illinois Department may provide for remittance by other means
if (i) the amount due is less than $10,000 or (ii) electronic
funds transfer is unavailable for this purpose.
(Source: P.A. 97-688, eff. 6-14-12; 97-689, eff. 6-14-12;
98-104, eff. 7-22-13.)
(305 ILCS 5/5A-5) (from Ch. 23, par. 5A-5)
Sec. 5A-5. Notice; penalty; maintenance of records.
(a) The Illinois Department shall send a notice of
assessment to every hospital provider subject to assessment
under this Article. The notice of assessment shall notify the
hospital of its assessment and shall be sent after receipt by
the Department of notification from the Centers for Medicare
and Medicaid Services of the U.S. Department of Health and
Human Services that the payment methodologies required under
this Article and, if necessary, the waiver granted under 42 CFR
433.68 have been approved. The notice shall be on a form
prepared by the Illinois Department and shall state the
following:
(1) The name of the hospital provider.
(2) The address of the hospital provider's principal
place of business from which the provider engages in the
occupation of hospital provider in this State, and the name
and address of each hospital operated, conducted, or
maintained by the provider in this State.
(3) The occupied bed days, occupied bed days less
Medicare days, adjusted gross hospital revenue, or
outpatient gross revenue of the hospital provider
(whichever is applicable), the amount of assessment
imposed under Section 5A-2 for the State fiscal year for
which the notice is sent, and the amount of each
installment to be paid during the State fiscal year.
(4) (Blank).
(5) Other reasonable information as determined by the
Illinois Department.
(b) If a hospital provider conducts, operates, or maintains
more than one hospital licensed by the Illinois Department of
Public Health, the provider shall pay the assessment for each
hospital separately.
(c) Notwithstanding any other provision in this Article, in
the case of a person who ceases to conduct, operate, or
maintain a hospital in respect of which the person is subject
to assessment under this Article as a hospital provider, the
assessment for the State fiscal year in which the cessation
occurs shall be adjusted by multiplying the assessment computed
under Section 5A-2 by a fraction, the numerator of which is the
number of days in the year during which the provider conducts,
operates, or maintains the hospital and the denominator of
which is 365. Immediately upon ceasing to conduct, operate, or
maintain a hospital, the person shall pay the assessment for
the year as so adjusted (to the extent not previously paid).
(d) Notwithstanding any other provision in this Article, a
provider who commences conducting, operating, or maintaining a
hospital, upon notice by the Illinois Department, shall pay the
assessment computed under Section 5A-2 and subsection (e) in
installments on the due dates stated in the notice and on the
regular installment due dates for the State fiscal year
occurring after the due dates of the initial notice.
(e) Notwithstanding any other provision in this Article,
for State fiscal years 2009 through 2018, in the case of a
hospital provider that did not conduct, operate, or maintain a
hospital in 2005, the assessment for that State fiscal year
shall be computed on the basis of hypothetical occupied bed
days for the full calendar year as determined by the Illinois
Department. Notwithstanding any other provision in this
Article, for the portion of State fiscal year 2012 beginning
June 10, 2012 through June 30, 2012, and for State fiscal years
2013 through 2018, in the case of a hospital provider that did
not conduct, operate, or maintain a hospital in 2009, the
assessment under subsection (b-5) of Section 5A-2 for that
State fiscal year shall be computed on the basis of
hypothetical gross outpatient revenue for the full calendar
year as determined by the Illinois Department.
Notwithstanding any other provision in this Article, for
State fiscal years 2019 through 2024, in the case of a hospital
provider that did not conduct, operate, or maintain a hospital
in the year that is the basis of the calculation of the
assessment under this Article, the assessment under paragraph
(3) of subsection (a) of Section 5A-2 for the State fiscal year
shall be computed on the basis of hypothetical occupied bed
days for the full calendar year as determined by the Illinois
Department, except that for a hospital provider that did not
have a 2015 Medicare cost report, but paid an assessment in
State fiscal year 2018 on the basis of hypothetical data, that
assessment amount shall be used for State fiscal years 2019 and
2020; however, for State fiscal year 2020, the assessment
amount shall be increased by the proportion that it represents
of the total annual assessment that is generated from all
hospitals in order to generate $6,250,000 in the aggregate for
that period from all hospitals subject to the annual assessment
under this paragraph.
Notwithstanding any other provision in this Article, for
State fiscal years 2019 through 2024, in the case of a hospital
provider that did not conduct, operate, or maintain a hospital
in the year that is the basis of the calculation of the
assessment under this Article, the assessment under subsection
(b-5) of Section 5A-2 for that State fiscal year shall be
computed on the basis of hypothetical gross outpatient revenue
for the full calendar year as determined by the Illinois
Department, except that for a hospital provider that did not
have a 2015 Medicare cost report, but paid an assessment in
State fiscal year 2018 on the basis of hypothetical data, that
assessment amount shall be used for State fiscal years 2019 and
2020; however, for State fiscal year 2020, the assessment
amount shall be increased by the proportion that it represents
of the total annual assessment that is generated from all
hospitals in order to generate $6,250,000 in the aggregate for
that period from all hospitals subject to the annual assessment
under this paragraph.
(f) Every hospital provider subject to assessment under
this Article shall keep sufficient records to permit the
determination of adjusted gross hospital revenue for the
hospital's fiscal year. All such records shall be kept in the
English language and shall, at all times during regular
business hours of the day, be subject to inspection by the
Illinois Department or its duly authorized agents and
employees.
(g) The Illinois Department may, by rule, provide a
hospital provider a reasonable opportunity to request a
clarification or correction of any clerical or computational
errors contained in the calculation of its assessment, but such
corrections shall not extend to updating the cost report
information used to calculate the assessment.
(h) (Blank).
(Source: P.A. 98-104, eff. 7-22-13; 98-463, eff. 8-16-13;
98-651, eff. 6-16-14; 98-756, eff. 7-16-14; 99-78, eff.
7-20-15.)
(305 ILCS 5/5A-8) (from Ch. 23, par. 5A-8)
Sec. 5A-8. Hospital Provider Fund.
(a) There is created in the State Treasury the Hospital
Provider Fund. Interest earned by the Fund shall be credited to
the Fund. The Fund shall not be used to replace any moneys
appropriated to the Medicaid program by the General Assembly.
(b) The Fund is created for the purpose of receiving moneys
in accordance with Section 5A-6 and disbursing moneys only for
the following purposes, notwithstanding any other provision of
law:
(1) For making payments to hospitals as required under
this Code, under the Children's Health Insurance Program
Act, under the Covering ALL KIDS Health Insurance Act, and
under the Long Term Acute Care Hospital Quality Improvement
Transfer Program Act.
(2) For the reimbursement of moneys collected by the
Illinois Department from hospitals or hospital providers
through error or mistake in performing the activities
authorized under this Code.
(3) For payment of administrative expenses incurred by
the Illinois Department or its agent in performing
activities under this Code, under the Children's Health
Insurance Program Act, under the Covering ALL KIDS Health
Insurance Act, and under the Long Term Acute Care Hospital
Quality Improvement Transfer Program Act.
(4) For payments of any amounts which are reimbursable
to the federal government for payments from this Fund which
are required to be paid by State warrant.
(5) For making transfers, as those transfers are
authorized in the proceedings authorizing debt under the
Short Term Borrowing Act, but transfers made under this
paragraph (5) shall not exceed the principal amount of debt
issued in anticipation of the receipt by the State of
moneys to be deposited into the Fund.
(6) For making transfers to any other fund in the State
treasury, but transfers made under this paragraph (6) shall
not exceed the amount transferred previously from that
other fund into the Hospital Provider Fund plus any
interest that would have been earned by that fund on the
monies that had been transferred.
(6.5) For making transfers to the Healthcare Provider
Relief Fund, except that transfers made under this
paragraph (6.5) shall not exceed $60,000,000 in the
aggregate.
(7) For making transfers not exceeding the following
amounts, related to State fiscal years 2013 through 2018,
to the following designated funds:
Health and Human Services Medicaid Trust
Fund..............................$20,000,000
Long-Term Care Provider Fund..........$30,000,000
General Revenue Fund.................$80,000,000.
Transfers under this paragraph shall be made within 7 days
after the payments have been received pursuant to the
schedule of payments provided in subsection (a) of Section
5A-4.
(7.1) (Blank).
(7.5) (Blank).
(7.8) (Blank).
(7.9) (Blank).
(7.10) For State fiscal year 2014, for making transfers
of the moneys resulting from the assessment under
subsection (b-5) of Section 5A-2 and received from hospital
providers under Section 5A-4 and transferred into the
Hospital Provider Fund under Section 5A-6 to the designated
funds not exceeding the following amounts in that State
fiscal year:
Healthcare Provider Relief Fund......$100,000,000
Transfers under this paragraph shall be made within 7
days after the payments have been received pursuant to the
schedule of payments provided in subsection (a) of Section
5A-4.
The additional amount of transfers in this paragraph
(7.10), authorized by Public Act 98-651, shall be made
within 10 State business days after June 16, 2014 (the
effective date of Public Act 98-651). That authority shall
remain in effect even if Public Act 98-651 does not become
law until State fiscal year 2015.
(7.10a) For State fiscal years 2015 through 2018, for
making transfers of the moneys resulting from the
assessment under subsection (b-5) of Section 5A-2 and
received from hospital providers under Section 5A-4 and
transferred into the Hospital Provider Fund under Section
5A-6 to the designated funds not exceeding the following
amounts related to each State fiscal year:
Healthcare Provider Relief Fund......$50,000,000
Transfers under this paragraph shall be made within 7
days after the payments have been received pursuant to the
schedule of payments provided in subsection (a) of Section
5A-4.
(7.11) (Blank).
(7.12) For State fiscal year 2013, for increasing by
21/365ths the transfer of the moneys resulting from the
assessment under subsection (b-5) of Section 5A-2 and
received from hospital providers under Section 5A-4 for the
portion of State fiscal year 2012 beginning June 10, 2012
through June 30, 2012 and transferred into the Hospital
Provider Fund under Section 5A-6 to the designated funds
not exceeding the following amounts in that State fiscal
year:
Healthcare Provider Relief Fund.......$2,870,000
Since the federal Centers for Medicare and Medicaid
Services approval of the assessment authorized under
subsection (b-5) of Section 5A-2, received from hospital
providers under Section 5A-4 and the payment methodologies
to hospitals required under Section 5A-12.4 was not
received by the Department until State fiscal year 2014 and
since the Department made retroactive payments during
State fiscal year 2014 related to the referenced period of
June 2012, the transfer authority granted in this paragraph
(7.12) is extended through the date that is 10 State
business days after June 16, 2014 (the effective date of
Public Act 98-651).
(7.13) In addition to any other transfers authorized
under this Section, for State fiscal years 2017 and 2018,
for making transfers to the Healthcare Provider Relief Fund
of moneys collected from the ACA Assessment Adjustment
authorized under subsections (a) and (b-5) of Section 5A-2
and paid by hospital providers under Section 5A-4 into the
Hospital Provider Fund under Section 5A-6 for each State
fiscal year. Timing of transfers to the Healthcare Provider
Relief Fund under this paragraph shall be at the discretion
of the Department, but no less frequently than quarterly.
(7.14) For making transfers not exceeding the
following amounts, related to State fiscal years 2019
through 2024, to the following designated funds:
Health and Human Services Medicaid Trust
Fund..............................$20,000,000
Long-Term Care Provider Fund..........$30,000,000
Health Care Provider Relief Fund....$325,000,000.
Transfers under this paragraph shall be made within 7
days after the payments have been received pursuant to the
schedule of payments provided in subsection (a) of Section
5A-4.
(8) For making refunds to hospital providers pursuant
to Section 5A-10.
(9) For making payment to capitated managed care
organizations as described in subsections (s) and (t) of
Section 5A-12.2 and subsection (r) of Section 5A-12.6 of
this Code.
Disbursements from the Fund, other than transfers
authorized under paragraphs (5) and (6) of this subsection,
shall be by warrants drawn by the State Comptroller upon
receipt of vouchers duly executed and certified by the Illinois
Department.
(c) The Fund shall consist of the following:
(1) All moneys collected or received by the Illinois
Department from the hospital provider assessment imposed
by this Article.
(2) All federal matching funds received by the Illinois
Department as a result of expenditures made by the Illinois
Department that are attributable to moneys deposited in the
Fund.
(3) Any interest or penalty levied in conjunction with
the administration of this Article.
(3.5) As applicable, proceeds from surety bond
payments payable to the Department as referenced in
subsection (s) of Section 5A-12.2 of this Code.
(4) Moneys transferred from another fund in the State
treasury.
(5) All other moneys received for the Fund from any
other source, including interest earned thereon.
(d) (Blank).
(Source: P.A. 98-104, eff. 7-22-13; 98-463, eff. 8-16-13;
98-651, eff. 6-16-14; 98-756, eff. 7-16-14; 99-78, eff.
7-20-15; 99-516, eff. 6-30-16; 99-933, eff. 1-27-17; revised
2-15-17.)
(305 ILCS 5/5A-10) (from Ch. 23, par. 5A-10)
Sec. 5A-10. Applicability.
(a) The assessment imposed by subsection (a) of Section
5A-2 shall cease to be imposed and the Department's obligation
to make payments shall immediately cease, and any moneys
remaining in the Fund shall be refunded to hospital providers
in proportion to the amounts paid by them, if:
(1) The payments to hospitals required under this
Article are not eligible for federal matching funds under
Title XIX or XXI of the Social Security Act;
(2) For State fiscal years 2009 through 2018, and as
provided in Section 5A-16, the Department of Healthcare and
Family Services adopts any administrative rule change to
reduce payment rates or alters any payment methodology that
reduces any payment rates made to operating hospitals under
the approved Title XIX or Title XXI State plan in effect
January 1, 2008 except for:
(A) any changes for hospitals described in
subsection (b) of Section 5A-3;
(B) any rates for payments made under this Article
V-A;
(C) any changes proposed in State plan amendment
transmittal numbers 08-01, 08-02, 08-04, 08-06, and
08-07;
(D) in relation to any admissions on or after
January 1, 2011, a modification in the methodology for
calculating outlier payments to hospitals for
exceptionally costly stays, for hospitals reimbursed
under the diagnosis-related grouping methodology in
effect on July 1, 2011; provided that the Department
shall be limited to one such modification during the
36-month period after the effective date of this
amendatory Act of the 96th General Assembly;
(E) any changes affecting hospitals authorized by
Public Act 97-689;
(F) any changes authorized by Section 14-12 of this
Code, or for any changes authorized under Section 5A-15
of this Code; or
(G) any changes authorized under Section 5-5b.1.
(b) The assessment imposed by Section 5A-2 shall not take
effect or shall cease to be imposed, and the Department's
obligation to make payments shall immediately cease, if the
assessment is determined to be an impermissible tax under Title
XIX of the Social Security Act. Moneys in the Hospital Provider
Fund derived from assessments imposed prior thereto shall be
disbursed in accordance with Section 5A-8 to the extent federal
financial participation is not reduced due to the
impermissibility of the assessments, and any remaining moneys
shall be refunded to hospital providers in proportion to the
amounts paid by them.
(c) The assessments imposed by subsection (b-5) of Section
5A-2 shall not take effect or shall cease to be imposed, the
Department's obligation to make payments shall immediately
cease, and any moneys remaining in the Fund shall be refunded
to hospital providers in proportion to the amounts paid by
them, if the payments to hospitals required under Section
5A-12.4 or Section 5A-12.6 are not eligible for federal
matching funds under Title XIX of the Social Security Act.
(d) The assessments imposed by Section 5A-2 shall not take
effect or shall cease to be imposed, the Department's
obligation to make payments shall immediately cease, and any
moneys remaining in the Fund shall be refunded to hospital
providers in proportion to the amounts paid by them, if:
(1) for State fiscal years 2013 through 2018, and as
provided in Section 5A-16, the Department reduces any
payment rates to hospitals as in effect on May 1, 2012, or
alters any payment methodology as in effect on May 1, 2012,
that has the effect of reducing payment rates to hospitals,
except for any changes affecting hospitals authorized in
Public Act 97-689 and any changes authorized by Section
14-12 of this Code, and except for any changes authorized
under Section 5A-15, and except for any changes authorized
under Section 5-5b.1;
(2) for State fiscal years 2013 through 2018, and as
provided in Section 5A-16, the Department reduces any
supplemental payments made to hospitals below the amounts
paid for services provided in State fiscal year 2011 as
implemented by administrative rules adopted and in effect
on or prior to June 30, 2011, except for any changes
affecting hospitals authorized in Public Act 97-689 and any
changes authorized by Section 14-12 of this Code, and
except for any changes authorized under Section 5A-15, and
except for any changes authorized under Section 5-5b.1; or
(3) for State fiscal years 2015 through 2018, and as
provided in Section 5A-16, the Department reduces the
overall effective rate of reimbursement to hospitals below
the level authorized under Section 14-12 of this Code,
except for any changes under Section 14-12 or Section 5A-15
of this Code, and except for any changes authorized under
Section 5-5b.1.
(e) Beginning in State fiscal year 2019, the assessments
imposed under Section 5A-2 shall not take effect or shall cease
to be imposed, the Department's obligation to make payments
shall immediately cease, and any moneys remaining in the Fund
shall be refunded to hospital providers in proportion to the
amounts paid by them, if:
(1) the payments to hospitals required under Section
5A12.6 are not eligible for federal matching funds under
Title XIX of the Social Security Act; or
(2) the Department reduces the overall effective rate
of reimbursement to hospitals below the level authorized
under Section 14-12 of this Code, as in effect on December
31, 2017, except for any changes authorized under Sections
14-12 or Section 5A-15 of this Code, and except for any
changes authorized under changes to Sections 5A-12.2,
5A-12.4, 5A-12.5, 5A-12.6, and 14-12 made by this
amendatory Act of the 100th General Assembly.
(Source: P.A. 98-463, eff. 8-16-13; 98-651, eff. 6-16-14; 99-2,
eff. 3-26-15.)
(305 ILCS 5/5A-12.5)
Sec. 5A-12.5. Affordable Care Act adults; hospital access
payments.
(a) The Department shall, subject to federal approval,
mirror the Medical Assistance hospital reimbursement
methodology for Affordable Care Act adults who are enrolled
under a fee-for-service or capitated managed care program,
including hospital access payments as defined in Section
5A-12.2 of this Article and hospital access improvement
payments as defined in Section 5A-12.4 of this Article, in
compliance with the equivalent rate provisions of the
Affordable Care Act.
(b) If the fee-for-service payments authorized under this
Section are deemed to be increases to payments for a prior
period, the Department shall seek federal approval to issue
such increases for the payments made through the period ending
on June 30, 2018, or as provided in Section 5A-16, even if such
increases are paid out during an extended payment period beyond
such date. Payment of such increases beyond such date is
subject to federal approval. If the Department receives federal
approval of such increases, the Department shall pay such
increases on the same schedule as it had used for such payments
prior to June 30, 2018.
(c) As used in this Section, "Affordable Care Act" is the
collective term for the Patient Protection and Affordable Care
Act (Pub. L. 111-148) and the Health Care and Education
Reconciliation Act of 2010 (Pub. L. 111-152).
(Source: P.A. 98-651, eff. 6-16-14; 99-516, eff. 6-30-16.)
(305 ILCS 5/5A-12.6 new)
Sec. 5A-12.6. Continuation of hospital access payments on
or after July 1, 2018.
(a) To preserve and improve access to hospital services,
for hospital services rendered on or after July 1, 2018 the
Department shall, except for hospitals described in subsection
(b) of Section 5A-3, make payments to hospitals as set forth in
this Section. Payments under this Section are not due and
payable, however, until (i) the methodologies described in this
Section are approved by the federal government in an
appropriate State Plan amendment and (ii) the assessment
imposed under this Article is determined to be a permissible
tax under Title XIX of the Social Security Act. In determining
the hospital access payments authorized under subsections (f)
through (n) of this Section, unless otherwise specified, only
Illinois hospitals shall be eligible for a payment and total
Medicaid utilization statistics shall be used to determine the
payment amount. In determining the hospital access payments
authorized under subsection (d) and subsections (f) through (l)
of this Section, if a hospital ceases to receive payments from
the pool, the payments for all hospitals continuing to receive
payments from such pool shall be uniformly adjusted to fully
expend the aggregate amount of the pool, with such adjustment
being effective on the first day of the second month following
the date the hospital ceases to receive payments from such
pool.
(b) Phase in of funds to claims-based payments and updates.
To ensure access to hospital services, the Department may only
use funds financed by the assessment authorized under Section
5A-2 to increase claims-based payment rates, including
applicable policy add-on payments or adjusters, in accordance
with this subsection. To increase the claims-based payment
rates up to the amounts specified in this subsection, the
hospital access payments authorized in subsection (d) and
subsections (g) through (l) of this Section shall be uniformly
reduced.
(1) For State fiscal years 2019 and 2020, up to
$635,000,000 of the total spending financed from the
assessment authorized under Section 5A-2 that is intended
to pay for hospital services and the hospital supplemental
access payments authorized under subsections (d) and (f) of
Section 14-12 for payment in State fiscal year 2018 may be
used to increase claims-based hospital payment rates as
specified under Section 14-12.
(2) For State fiscal years 2021 and 2022, up to
$1,164,000,000 of the total spending financed from the
assessment authorized under Section 5A-2 that is intended
to pay for hospital services and the hospital supplemental
access payments authorized under subsections (d) and (f) of
Section 14-12 for payment in State Fiscal Year 2018 may be
used to increase claims-based hospital payment rates as
specified under Section 14-12.
(3) For State fiscal years 2023, up to $1,397,000,000
of the total spending financed from the assessment
authorized under Section 5A-2 that is intended to pay for
hospital services and the hospital supplemental access
payments authorized under subsections (d) and (f) of
Section 14-12 for payment in State Fiscal Year 2018 may be
used to increase claims-based hospital payment rates as
specified under Section 14-12.
(4) For State fiscal years 2024, up to $1,663,000,000
of the total spending financed from the assessment
authorized under Section 5A-2 that is intended to pay for
hospital services and the hospital supplemental access
payments authorized under subsections (d) and (f) of
Section 14-12 for payment in State Fiscal Year 2018 may be
used to increase claims-based hospital payment rates as
specified under Section 14-12.
(5) Beginning in State fiscal year 2021, and at least
every 24 months thereafter, the Department shall, by rule,
update the hospital access payments authorized under this
Section to take into account the amount of funds being used
to increase claims-based hospital payment rates under
Section 14-12 and to apply the most recently available data
and information, including data from the most recent base
year and qualifying criteria which shall correlate to the
updated base year data, to determine a hospital's
eligibility for each payment and the amount of the payment
authorized under this Section. Any updates of the hospital
access payment methodologies shall not result in any
diminishment of the aggregate amount of hospital access
payment expenditures, except for reductions attributable
to the use of such funds to increase claims-based hospital
payment rates as authorized by this Section. Nothing in
this Section shall be construed as precluding variations in
the amount of any individual hospital's access payments.
The Department shall publish the proposed rules to update
the hospital access payments at least 90 days before their
proposed effective date. The proposed rules shall not be
adopted using emergency rulemaking authority. The
Department shall notify each hospital, in writing, of the
impact of these updates on the hospital at least 30
calendar days prior to their effective date.
(c) The hospital access payments authorized under
subsections (d) through (n) of this Section shall be paid in 12
equal installments on or before the seventh State business day
of each month, except that no payment shall be due within 100
days after the later of the date of notification of federal
approval of the payment methodologies required under this
Section or any waiver required under 42 CFR 433.68, at which
time the sum of amounts required under this Section prior to
the date of notification is due and payable. Payments under
this Section are not due and payable, however, until (i) the
methodologies described in this Section are approved by the
federal government in an appropriate State Plan amendment and
(ii) the assessment imposed under this Article is determined to
be a permissible tax under Title XIX of the Social Security
Act. The Department may, when practicable, accelerate the
schedule upon which payments authorized under this Section are
made.
(d) Rate increase-based adjustment.
(1) From the funds financed by the assessment
authorized under Section 5A-2, individual funding pools by
category of service shall be established, for Inpatient
General Acute Care services in the amount of $268,051,572,
Inpatient Rehab Care services in the amount of $24,500,610,
Inpatient Psychiatric Care service in the amount of
$94,617,812, and Outpatient Care Services in the amount of
$328,828,641.
(2) Each Illinois hospital and other hospitals
authorized under this subsection, except for long-term
acute care hospitals and public hospitals, shall be
assigned a pool allocation percentage for each category of
service that is equal to the ratio of the hospital's
estimated FY2019 claims-based payments including all
applicable FY2019 policy adjusters, multiplied by the
applicable service credit factor for the hospital, divided
by the total of the FY2019 claims-based payments including
all FY2019 policy adjusters for each category of service
adjusted by each hospital's applicable service credit
factor for all qualified hospitals. For each category of
service, a hospital shall receive a supplemental payment
equal to its pool allocation percentage multiplied by the
total pool amount.
(3) Effective July 1, 2018, for purposes of determining
for State fiscal years 2019 and 2020 the hospitals eligible
for the payments authorized under this subsection, the
Department shall include children's hospitals located in
St. Louis that are designated a Level III perinatal center
by the Department of Public Health and also designated a
Level I pediatric trauma center by the Department of Public
Health as of December 1, 2017.
(4) As used in this subsection, "service credit factor"
is determined based on a hospital's Rate Year 2017 Medicaid
inpatient utilization rate ("MIUR") rounded to the nearest
whole percentage, as follows:
(A) Tier 1: A hospital with a MIUR equal to or
greater than 60% shall have a service credit factor of
200%.
(B) Tier 2: A hospital with a MIUR equal to or
greater than 33% but less than 60% shall have a service
credit factor of 100%.
(C) Tier 3: A hospital with a MIUR equal to or
greater than 20% but less than 33% shall have a service
credit factor of 50%.
(D) Tier 4: A hospital with a MIUR less than 20%
shall have a service credit factor of 10%.
(e) Graduate medical education.
(1) The calculation of graduate medical education
payments shall be based on the hospital's Medicare cost
report ending in Calendar Year 2015, as reported in
Medicare cost reports released on October 19, 2016 with
data through September 30, 2016. An Illinois hospital
reporting intern and resident cost on its Medicare cost
report shall be eligible for graduate medical education
payments.
(2) Each hospital's annualized Medicaid Intern
Resident Cost is calculated using annualized intern and
resident total costs obtained from Worksheet B Part I,
Column 21 and 22 the sum of Lines 30-43, 50-76, 90-93,
96-98, and 105-112 multiplied by the percentage that the
hospital's Medicaid days (Worksheet S3 Part I, Column 7,
Lines 14 and 16-18) comprise of the hospital's total days
(Worksheet S3 Part I, Column 8, Lines 14 and 16-18).
(3) An annualized Medicaid indirect medical education
(IME) payment is calculated for each hospital using its IME
payments (Worksheet E Part A, Line 29, Col 1) multiplied by
the percentage that its Medicaid days (Worksheet S3 Part I,
Column 7, Lines 14 and 16-18) comprise of its Medicare days
(Worksheet S3 Part I, Column 6, Lines 14 and 16-18).
(4) For each hospital, its annualized Medicaid Intern
Resident Cost and its annualized Medicaid IME payment are
summed and multiplied by 33% to determine the hospital's
final graduate medical education payment.
(f) Alzheimer's treatment access payment. Each Illinois
academic medical center or teaching hospital, as defined in
Section 5-5e.2 of this Code, that is identified as the primary
hospital affiliate of one of the Regional Alzheimer's Disease
Assistance Centers, as designated by the Alzheimer's Disease
Assistance Act and identified in the Department of Public
Health's Alzheimer's Disease State Plan dated December 2016,
shall be paid an Alzheimer's treatment access payment equal to
the product of $10,000,000 multiplied by a fraction, the
numerator of which is the qualifying hospital's Fiscal Year
2015 total admissions and the denominator of which is the
Fiscal Year 2015 total admissions for all hospitals eligible
for the payment.
(g) Safety-net hospital, private critical access hospital,
and outpatient high volume access payment.
(1) Each safety-net hospital, as defined in Section
5-5e.1 of this Code, for Rate Year 2017 that is not
publicly owned shall be paid an outpatient high volume
access payment equal to $40,000,000 multiplied by a
fraction, the numerator of which is the hospital's Fiscal
Year 2015 outpatient services and the denominator of which
is the Fiscal Year 2015 outpatient services for all
hospitals eligible under this paragraph for this payment.
(2) Each critical access hospital that is not publicly
owned shall be paid an outpatient high volume access
payment equal to $55,000,000 multiplied by a fraction, the
numerator of which is the hospital's Fiscal Year 2015
outpatient services and the denominator of which is the
Fiscal Year 2015 outpatient services for all hospitals
eligible under this paragraph for this payment.
(3) Each tier 1 hospital that is not publicly owned
shall be paid an outpatient high volume access payment
equal to $25,000,000 multiplied by a fraction, the
numerator of which is the hospital's Fiscal Year 2015
outpatient services and the denominator of which is the
Fiscal Year 2015 outpatient services for all hospitals
eligible under this paragraph for this payment. A tier 1
outpatient high volume hospital means one of the following:
(i) a non-publicly owned hospital, excluding a safety net
hospital as defined in Section 5-5e.1 of this Code for Rate
Year 2017, with total outpatient services, equal to or
greater than the regional mean plus one standard deviation
for all hospitals in the region but less than the mean plus
1.5 standard deviation; (ii) an Illinois non-publicly
owned hospital with total outpatient service units equal to
or greater than the statewide mean plus one standard
deviation; or (iii) a non-publicly owned safety net
hospital as defined in Section 5-5e.1 of this Code for Rate
Year 2017, with total outpatient services, equal to or
greater than the regional mean plus one standard deviation
for all hospitals in the region.
(4) Each tier 2 hospital that is not publicly owned
shall be paid an outpatient high volume access payment
equal to $25,000,000 multiplied by a fraction, the
numerator of which is the hospital's Fiscal Year 2015
outpatient services and the denominator of which is the
Fiscal Year 2015 outpatient services for all hospitals
eligible under this paragraph for this payment. A tier 2
outpatient high volume hospital means a non-publicly owned
hospital, excluding a safety-net hospital as defined in
Section 5-5e.1 of this Code for Rate Year 2017, with total
outpatient services equal to or greater than the regional
mean plus 1.5 standard deviations for all hospitals in the
region but less than the mean plus 2 standard deviations.
(5) Each tier 3 hospital that is not publicly owned
shall be paid an outpatient high volume access payment
equal to $58,000,000 multiplied by a fraction, the
numerator of which is the hospital's Fiscal Year 2015
outpatient services and the denominator of which is the
Fiscal Year 2015 outpatient services for all hospitals
eligible under this paragraph for this payment. A tier 3
outpatient high volume hospital means a non-publicly owned
hospital, excluding a safety-net hospital as defined in
Section 5-5e.1 of this Code for Rate Year 2017, with total
outpatient services equal to or greater than the regional
mean plus 2 standard deviations for all hospitals in the
region.
(h) Medicaid dependent or high volume hospital access
payment.
(1) To qualify for a Medicaid dependent hospital access
payment, a hospital shall meet one of the following
criteria:
(A) Be a non-publicly owned general acute care
hospital that is a safety-net hospital, as defined in
Section 5-5e.1 of this Code, for Rate Year 2017.
(B) Be a pediatric hospital that is a safety net
hospital, as defined in Section 5-5e.1 of this Code,
for Rate Year 2017 and have a Medicaid inpatient
utilization rate equal to or greater than 50%.
(C) Be a general acute care hospital with a
Medicaid inpatient utilization rate equal to or
greater than 50% in Rate Year 2017.
(2) The Medicaid dependent hospital access payment
shall be determined as follows:
(A) Each tier 1 hospital shall be paid a Medicaid
dependent hospital access payment equal to $23,000,000
multiplied by a fraction, the numerator of which is the
hospital's Fiscal Year 2015 total days and the
denominator of which is the Fiscal Year 2015 total days
for all hospitals eligible under this subparagraph for
this payment. A tier 1 Medicaid dependent hospital
means a qualifying hospital with a Rate Year 2017
Medicaid inpatient utilization rate equal to or
greater than the statewide mean but less than the
statewide mean plus 0.5 standard deviation.
(B) Each tier 2 hospital shall be paid a Medicaid
dependent hospital access payment equal to $15,000,000
multiplied by a fraction, the numerator of which is the
hospital's Fiscal Year 2015 total days and the
denominator of which is the Fiscal Year 2015 total days
for all hospitals eligible under this subparagraph for
this payment. A tier 2 Medicaid dependent hospital
means a qualifying hospital with a Rate Year 2017
Medicaid inpatient utilization rate equal to or
greater than the statewide mean plus 0.5 standard
deviations but less than the statewide mean plus one
standard deviation.
(C) Each tier 3 hospital shall be paid a Medicaid
dependent hospital access payment equal to $15,000,000
multiplied by a fraction, the numerator of which is the
hospital's Fiscal Year 2015 total days and the
denominator of which is the Fiscal Year 2015 total days
for all hospitals eligible under this subparagraph for
this payment. A tier 3 Medicaid dependent hospital
means a qualifying hospital with a Rate Year 2017
Medicaid inpatient utilization rate equal to or
greater than the statewide mean plus one standard
deviation but less than the statewide mean plus 1.5
standard deviations.
(D) Each tier 4 hospital shall be paid a Medicaid
dependent hospital access payment equal to $53,000,000
multiplied by a fraction, the numerator of which is the
hospital's Fiscal Year 2015 total days and the
denominator of which is the Fiscal Year 2015 total days
for all hospitals eligible under this subparagraph for
this payment. A tier 4 Medicaid dependent hospital
means a qualifying hospital with a Rate Year 2017
Medicaid inpatient utilization rate equal to or
greater than the statewide mean plus 1.5 standard
deviations but less than the statewide mean plus 2
standard deviations.
(E) Each tier 5 hospital shall be paid a Medicaid
dependent hospital access payment equal to $75,000,000
multiplied by a fraction, the numerator of which is the
hospital's Fiscal Year 2015 total days and the
denominator of which is the Fiscal Year 2015 total days
for all hospitals eligible under this subparagraph for
this payment. A tier 5 Medicaid dependent hospital
means a qualifying hospital with a Rate Year 2017
Medicaid inpatient utilization rate equal to or
greater than the statewide mean plus 2 standard
deviations.
(3) Each Medicaid high volume hospital shall be paid a
Medicaid high volume access payment equal to $300,000,000
multiplied by a fraction, the numerator of which is the
hospital's Fiscal Year 2015 total admissions and the
denominator of which is the Fiscal Year 2015 total
admissions for all hospitals eligible under this paragraph
for this payment. A Medicaid high volume hospital means the
Illinois general acute care hospitals with the highest
number of Fiscal Year 2015 total admissions that when
ranked in descending order from the highest Fiscal Year
2015 total admissions to the lowest Fiscal Year 2015 total
admissions, in the aggregate, sum to at least 50% of the
total admissions for all such hospitals in Fiscal Year
2015; however, any hospital which has qualified as a
Medicaid dependent hospital shall not also be considered a
Medicaid high volume hospital.
(i) Perinatal care access payment.
(1) Each Illinois non-publicly owned hospital
designated a Level II or II+ perinatal center by the
Department of Public Health as of December 1, 2017 shall be
paid an access payment equal to $200,000,000 multiplied by
a fraction, the numerator of which is the hospital's Fiscal
Year 2015 total admissions and the denominator of which is
the Fiscal Year 2015 total admissions for all hospitals
eligible under this paragraph for this payment.
(2) Each Illinois non-publicly owned hospital
designated a Level III perinatal center by the Department
of Public Health as of December 1, 2017 shall be paid an
access payment equal to $100,000,000 multiplied by a
fraction, the numerator of which is the hospital's Fiscal
Year 2015 total admissions and the denominator of which is
the Fiscal Year 2015 total admissions for all hospitals
eligible under this paragraph for this payment.
(j) Trauma care access payment.
(1) Each Illinois non-publicly owned hospital
designated a Level I trauma center by the Department of
Public Health as of December 1, 2017 shall be paid an
access payment equal to $160,000,000 multiplied by a
fraction, the numerator of which is the hospital's Fiscal
Year 2015 total admissions and the denominator of which is
the Fiscal Year 2015 total admissions for all hospitals
eligible under this paragraph for this payment.
(2) Each Illinois non-publicly owned hospital
designated a Level II trauma center by the Department of
Public Health as of December 1, 2017 shall be paid an
access payment equal to $200,000,000 multiplied by a
fraction, the numerator of which is the hospital's Fiscal
Year 2015 total admissions and the denominator of which is
the Fiscal Year 2015 total admissions for all hospitals
eligible under this paragraph for this payment.
(k) Perinatal and trauma center access payment.
(1) Each Illinois non-publicly owned hospital
designated a Level III perinatal center and a Level I or II
trauma center by the Department of Public Health as of
December 1, 2017, and that has a Rate Year 2017 Medicaid
inpatient utilization rate equal to or greater than 20% and
a calendar year 2015 occupancy ratio equal to or greater
than 50%, shall be paid an access payment equal to
$160,000,000 multiplied by a fraction, the numerator of
which is the hospital's Fiscal Year 2015 total admissions
and the denominator of which is the Fiscal Year 2015 total
admissions for all hospitals eligible under this paragraph
for this payment.
(2) Each Illinois non-publicly owned hospital
designated a Level II or II+ perinatal center and a Level I
or II trauma center by the Department of Public Health as
of December 1, 2017, and that has a Rate Year 2017 Medicaid
inpatient utilization rate equal to or greater than 20% and
a calendar year 2015 occupancy ratio equal to or greater
than 50%, shall be paid an access payment equal to
$200,000,000 multiplied by a fraction, the numerator of
which is the hospital's Fiscal Year 2015 total admissions
and the denominator of which is the Fiscal Year 2015 total
admissions for all hospitals eligible under this paragraph
for this payment.
(l) Long-term acute care access payment. Each Illinois
non-publicly owned long-term acute care hospital that has a
Rate Year 2017 Medicaid inpatient utilization rate equal to or
greater than 25% and a calendar year 2015 occupancy ratio equal
to or greater than 60% shall be paid an access payment equal to
$19,000,000 multiplied by a fraction, the numerator of which is
the hospital's Fiscal Year 2015 general acute care admissions
and the denominator of which is the Fiscal Year 2015 general
acute care admissions for all hospitals eligible under this
subsection for this payment.
(m) Small public hospital access payment.
(1) As used in this subsection, "small public hospital"
means any Illinois publicly owned hospital which is not a
"large public hospital" as described in 89 Ill. Adm. Code
148.25(a).
(2) Each small public hospital shall be paid an
inpatient access payment equal to $2,825,000 multiplied by
a fraction, the numerator of which is the hospital's Fiscal
Year 2015 total days and the denominator of which is the
Fiscal Year 2015 total days for all hospitals under this
paragraph for this payment.
(3) Each small public hospital shall be paid an
outpatient access payment equal to $24,000,000 multiplied
by a fraction, the numerator of which is the hospital's
Fiscal Year 2015 outpatient services and the denominator of
which is the Fiscal Year 2015 outpatient services for all
hospitals eligible under this paragraph for this payment.
(n) Psychiatric care access payment. In addition to rates
paid for inpatient psychiatric services, the Illinois
Department shall, by rule, establish an access payment for
inpatient hospital psychiatric services that shall, in the
aggregate, spend approximately $61,141,188 annually. In
consultation with the hospital community, the Department may,
by rule, incorporate the funds used for this access payment to
increase the payment rates for inpatient psychiatric services,
except that such changes shall not take effect before July 1,
2019. Upon incorporation into the claims payment rates, this
access payment shall be repealed. Beginning July 1, 2018, for
purposes of determining for State fiscal years 2019 and 2020
the hospitals eligible for the payments authorized under this
subsection, the Department shall include out-of-state
hospitals that are designated a Level I pediatric trauma center
or a Level I trauma center by the Department of Public Health
as of December 1, 2017.
(o) For purposes of this Section, a hospital that is
enrolled to provide Medicaid services during State fiscal year
2015 shall have its utilization and associated reimbursements
annualized prior to the payment calculations being performed
under this Section.
(p) Definitions. As used in this Section, unless the
context requires otherwise:
"General acute care admissions" means, for a given
hospital, the sum of inpatient hospital admissions provided to
recipients of medical assistance under Title XIX of the Social
Security Act for general acute care, excluding admissions for
individuals eligible for Medicare under Title XVIII of the
Social Security Act (Medicaid/Medicare crossover admissions),
as tabulated from the Department's paid claims data for general
acute care admissions occurring during State fiscal year 2015
that was adjudicated by the Department through October 28,
2016.
"Occupancy ratio" is determined utilizing the IDPH
Hospital Profile CY15 Facility Utilization Data Source 2015
Annual Hospital Questionnaire. Utilizes all beds and days
including observation days but excludes Long Term Care and
Swing bed and their associated beds and days.
"Outpatient services" means, for a given hospital, the sum
of the number of outpatient encounters identified as unique
services provided to recipients of medical assistance under
Title XIX of the Social Security Act for general acute care,
psychiatric care, and rehabilitation care, excluding
outpatient services for individuals eligible for Medicare
under Title XVIII of the Social Security Act (Medicaid/Medicare
crossover services), as tabulated from the Department's paid
claims data for outpatient services occurring during State
fiscal year 2015 that was adjudicated by the Department through
October 28, 2016.
"Total days" means, for a given hospital, the sum of
inpatient hospital days provided to recipients of medical
assistance under Title XIX of the Social Security Act for
general acute care, psychiatric care, and rehabilitation care,
excluding days for individuals eligible for Medicare under
Title XVIII of the Social Security Act (Medicaid/Medicare
crossover days), as tabulated from the Department's paid claims
data for total days occurring during State fiscal year 2015
that was adjudicated by the Department through October 28,
2016.
"Total admissions" means, for a given hospital, the sum of
inpatient hospital admissions provided to recipients of
medical assistance under Title XIX of the Social Security Act
for general acute care, psychiatric care, and rehabilitation
care, excluding admissions for individuals eligible for
Medicare under Title XVIII of that Act (Medicaid/Medicare
crossover admissions), as tabulated from the Department's paid
claims data for admissions occurring during State fiscal year
2015 that was adjudicated by the Department through October 28,
2016.
(q) Notwithstanding any of the other provisions of this
Section, the Department is authorized to adopt rules that
change the hospital access payments specified in this Section,
but only to the extent necessary to conform to any federally
approved amendment to the Title XIX State Plan. Any such rules
shall be adopted by the Department as authorized by Section
5-50 of the Illinois Administrative Procedure Act.
Notwithstanding any other provision of law, any changes
implemented as a result of this subsection (q) shall be given
retroactive effect so that they shall be deemed to have taken
effect as of the effective date of this amendatory Act of the
100th General Assembly.
(r) On or after July 1, 2018, and no less than annually
thereafter, the Department shall increase capitation payments
to capitated managed care organizations (MCOs) to equal the
aggregate reduction of payments made in this Section to
preserve access to hospital services for recipients under the
Medical Assistance Program. The aggregate amount of all
increased capitation payments to all MCOs for a fiscal year
shall at least be the amount needed to avoid reduction in
payments authorized under Section 5A-15. Payments to MCOs under
this Section shall be consistent with actuarial certification
and shall be published by the Department each year. Managed
care organizations and hospitals (including through their
representative organizations), shall develop and implement
methodologies and rates for payments that will preserve and
improve access to hospital services for recipients in
furtherance of the State's public policy to ensure equal access
to covered services to recipients under the Medical Assistance
Program. The Department shall make available, on a monthly
basis, a report of the capitation payments that are made to
each MCO, including the number of enrollees for which such
payment is made, the per enrollee amount of the payment, and
any adjustments that have been made. Payments to MCOs that
would be paid consistent with actuarial certification and
enrollment in the absence of the increased capitation payments
under this Section shall not be reduced as a consequence of
payments made under this subsection.
As used in this subsection, "MCO" means an entity which
contracts with the Department to provide services where payment
for medical services is made on a capitated basis.
(305 ILCS 5/5A-13)
Sec. 5A-13. Emergency rulemaking.
(a) The Department of Healthcare and Family Services
(formerly Department of Public Aid) may adopt rules necessary
to implement this amendatory Act of the 94th General Assembly
through the use of emergency rulemaking in accordance with
Section 5-45 of the Illinois Administrative Procedure Act. For
purposes of that Act, the General Assembly finds that the
adoption of rules to implement this amendatory Act of the 94th
General Assembly is deemed an emergency and necessary for the
public interest, safety, and welfare.
(b) The Department of Healthcare and Family Services may
adopt rules necessary to implement this amendatory Act of the
97th General Assembly through the use of emergency rulemaking
in accordance with Section 5-45 of the Illinois Administrative
Procedure Act. For purposes of that Act, the General Assembly
finds that the adoption of rules to implement this amendatory
Act of the 97th General Assembly is deemed an emergency and
necessary for the public interest, safety, and welfare.
(c) The Department of Healthcare and Family Services may
adopt rules necessary to initially implement the changes to
Articles 5, 5A, 12, and 14 of this Code under this amendatory
Act of the 100th General Assembly through the use of emergency
rulemaking in accordance with subsection (aa) of Section 5-45
of the Illinois Administrative Procedure Act. For purposes of
that Act, the General Assembly finds that the adoption of rules
to implement the changes to Articles 5, 5A, 12, and 14 of this
Code under this amendatory Act of the 100th General Assembly is
deemed an emergency and necessary for the public interest,
safety, and welfare. The 24-month limitation on the adoption of
emergency rules does not apply to rules adopted to initially
implement the changes to Articles 5, 5A, 12, and 14 of this
Code under this amendatory Act of the 100th General Assembly.
For purposes of this subsection, "initially" means any
emergency rules necessary to immediately implement the changes
authorized to Articles 5, 5A, 12, and 14 of this Code under
this amendatory Act of the 100th General Assembly; however,
emergency rulemaking authority shall not be used to make
changes that could otherwise be made following the process
established in the Illinois Administrative Procedure Act.
(Source: P.A. 97-688, eff. 6-14-12.)
(305 ILCS 5/5A-14)
Sec. 5A-14. Repeal of assessments and disbursements.
(a) Section 5A-2 is repealed on July 1, 2020 2018.
(b) Section 5A-12 is repealed on July 1, 2005.
(c) Section 5A-12.1 is repealed on July 1, 2008.
(d) Section 5A-12.2 and Section 5A-12.4 are repealed on
July 1, 2018, subject to Section 5A-16.
(e) Section 5A-12.3 is repealed on July 1, 2011.
(f) Section 5A-12.6 is repealed on July 1, 2020.
(Source: P.A. 97-688, eff. 6-14-12; 97-689, eff. 6-14-12;
98-651, eff. 6-16-14.)
(305 ILCS 5/5A-15)
Sec. 5A-15. Protection of federal revenue.
(a) If the federal Centers for Medicare and Medicaid
Services finds that any federal upper payment limit applicable
to the payments under this Article is exceeded then:
(1) (i) if such finding is made before payments have
been issued, the payments under this Article and the
increases in claims-based hospital payment rates specified
under Section 14-12 of this Code, as authorized under this
amendatory Act of the 100th General Assembly, that exceed
the applicable federal upper payment limit shall be reduced
uniformly to the extent necessary to comply with the
applicable federal upper payment limit; or (ii) if such
finding is made after payments have been issued, the
payments under this Article that exceed the applicable
federal upper payment limit shall be reduced uniformly to
the extent necessary to comply with the applicable federal
upper payment limit; and
(2) any assessment rate imposed under this Article
shall be reduced such that the aggregate assessment is
reduced by the same percentage reduction applied in
paragraph (1); and
(3) any transfers from the Hospital Provider Fund under
Section 5A-8 shall be reduced by the same percentage
reduction applied in paragraph (1).
(b) Any payment reductions made under the authority granted
in this Section are exempt from the requirements and actions
under Section 5A-10.
(Source: P.A. 97-688, eff. 6-14-12; 97-689, eff. 6-14-12.)
(305 ILCS 5/5A-16 new)
Sec. 5A-16. State fiscal year 2019 implementation
protection. To preserve access to hospital services, it is the
intent of the General Assembly that there not be a gap in
payments to hospitals while the changes authorized under this
amendatory Act of the 100th General Assembly are being reviewed
by the federal Centers for Medicare and Medicaid Services and
implemented by the Department. Therefore, pending the review
and approval of the changes to the assessment and hospital
reimbursement methodologies authorized under this amendatory
Act of the 100th General Assembly by the federal Centers for
Medicare and Medicaid Services and the final implementation of
such program by the Department, the Department shall take all
actions necessary to continue the reimbursement methodologies
and payments to hospitals that are changed under this
amendatory Act of the 100th General Assembly, as they are in
effect on June 30, 2018, until the first day of the second
month after the new and revised methodologies and payments
authorized under this amendatory Act of the 100th General
Assembly are effective and implemented by the Department. Such
actions by the Department shall include, but not be limited to,
requesting the extension of any federal approval of the
currently approved payment methodologies contained in
Illinois' Medicaid State Plan while the federal Centers for
Medicare and Medicaid Services reviews the proposed changes
authorized under this amendatory Act of the 100th General
Assembly.
Notwithstanding any other provision of this Code, if the
federal Centers for Medicare and Medicaid Services should
approve the continuation of the reimbursement methodologies
and payments to hospitals under Sections 5A-12.2, 5A-12.4,
5A-12.5, and Section 14-12, as they are in effect on June 30,
2018, until the new and revised methodologies and payments
authorized under Sections 5A-12.6 and Section 14-12 of this
amendatory Act of the 100th General Assembly are federally
approved, then the reimbursement methodologies and payments to
hospitals under Sections 5A-12.2, 5A-12.4, 5A-12.5, and 14-12,
and the assessments imposed under Section 5A-2, as they are in
effect on June 30, 2018, shall continue until the effective
date of the new and revised methodologies and payments, which
shall be the first day of the second month following the date
of approval by the federal Centers for Medicare and Medicaid
Services.
(305 ILCS 5/12-4.105)
Sec. 12-4.105. Human poison control center; payment
program. Subject to funding availability resulting from
transfers made from the Hospital Provider Fund to the
Healthcare Provider Relief Fund as authorized under this Code,
for State fiscal year 2017 and State fiscal year 2018, and for
each State fiscal year thereafter in which the assessment under
Section 5A-2 is imposed, the Department of Healthcare and
Family Services shall pay to the human poison control center
designated under the Poison Control System Act an amount of not
less than $3,000,000 for each of those State fiscal years that
the human poison control center is in operation.
(Source: P.A. 99-516, eff. 6-30-16.)
(305 ILCS 5/14-12)
Sec. 14-12. Hospital rate reform payment system. The
hospital payment system pursuant to Section 14-11 of this
Article shall be as follows:
(a) Inpatient hospital services. Effective for discharges
on and after July 1, 2014, reimbursement for inpatient general
acute care services shall utilize the All Patient Refined
Diagnosis Related Grouping (APR-DRG) software, version 30,
distributed by 3MTM Health Information System.
(1) The Department shall establish Medicaid weighting
factors to be used in the reimbursement system established
under this subsection. Initial weighting factors shall be
the weighting factors as published by 3M Health Information
System, associated with Version 30.0 adjusted for the
Illinois experience.
(2) The Department shall establish a
statewide-standardized amount to be used in the inpatient
reimbursement system. The Department shall publish these
amounts on its website no later than 10 calendar days prior
to their effective date.
(3) In addition to the statewide-standardized amount,
the Department shall develop adjusters to adjust the rate
of reimbursement for critical Medicaid providers or
services for trauma, transplantation services, perinatal
care, and Graduate Medical Education (GME).
(4) The Department shall develop add-on payments to
account for exceptionally costly inpatient stays,
consistent with Medicare outlier principles. Outlier fixed
loss thresholds may be updated to control for excessive
growth in outlier payments no more frequently than on an
annual basis, but at least triennially. Upon updating the
fixed loss thresholds, the Department shall be required to
update base rates within 12 months.
(5) The Department shall define those hospitals or
distinct parts of hospitals that shall be exempt from the
APR-DRG reimbursement system established under this
Section. The Department shall publish these hospitals'
inpatient rates on its website no later than 10 calendar
days prior to their effective date.
(6) Beginning July 1, 2014 and ending on June 30, 2024
2018, in addition to the statewide-standardized amount,
the Department shall develop an adjustor to adjust the rate
of reimbursement for safety-net hospitals defined in
Section 5-5e.1 of this Code excluding pediatric hospitals.
(7) Beginning July 1, 2014 and ending on June 30, 2020,
or upon implementation of inpatient psychiatric rate
increases as described in subsection (n) of Section 5A-12.6
2018, in addition to the statewide-standardized amount,
the Department shall develop an adjustor to adjust the rate
of reimbursement for Illinois freestanding inpatient
psychiatric hospitals that are not designated as
children's hospitals by the Department but are primarily
treating patients under the age of 21.
(7.5) Beginning July 1, 2020, the reimbursement for
inpatient psychiatric services shall be so that base claims
projected reimbursement is increased by an amount equal to
the funds allocated in paragraph (2) of subsection (b) of
Section 5A-12.6, less the amount allocated under
paragraphs (8) and (9) of this subsection and paragraphs
(3) and (4) of subsection (b) multiplied by 13%. Beginning
July 1, 2022, the reimbursement for inpatient psychiatric
services shall be so that base claims projected
reimbursement is increased by an amount equal to the funds
allocated in paragraph (3) of subsection (b) of Section
5A-12.6, less the amount allocated under paragraphs (8) and
(9) of this subsection and paragraphs (3) and (4) of
subsection (b) multiplied by 13%. Beginning July 1, 2024,
the reimbursement for inpatient psychiatric services shall
be so that base claims projected reimbursement is increased
by an amount equal to the funds allocated in paragraph (4)
of subsection (b) of Section 5A-12.6, less the amount
allocated under paragraphs (8) and (9) of this subsection
and paragraphs (3) and (4) of subsection (b) multiplied by
13%.
(8) Beginning July 1, 2018, in addition to the
statewide-standardized amount, the Department shall adjust
the rate of reimbursement for hospitals designated by the
Department of Public Health as a Perinatal Level II or II+
center by applying the same adjustor that is applied to
Perinatal and Obstetrical care cases for Perinatal Level
III centers, as of December 31, 2017.
(9) Beginning July 1, 2018, in addition to the
statewide-standardized amount, the Department shall apply
the same adjustor that is applied to trauma cases as of
December 31, 2017 to inpatient claims to treat patients
with burns, including, but not limited to, APR-DRGs 841,
842, 843, and 844.
(10) Beginning July 1, 2018, the
statewide-standardized amount for inpatient general acute
care services shall be uniformly increased so that base
claims projected reimbursement is increased by an amount
equal to the funds allocated in paragraph (1) of subsection
(b) of Section 5A-12.6, less the amount allocated under
paragraphs (8) and (9) of this subsection and paragraphs
(3) and (4) of subsection (b) multiplied by 40%. Beginning
July 1, 2020, the statewide-standardized amount for
inpatient general acute care services shall be uniformly
increased so that base claims projected reimbursement is
increased by an amount equal to the funds allocated in
paragraph (2) of subsection (b) of Section 5A-12.6, less
the amount allocated under paragraphs (8) and (9) of this
subsection and paragraphs (3) and (4) of subsection (b)
multiplied by 40%. Beginning July 1, 2022, the
statewide-standardized amount for inpatient general acute
care services shall be uniformly increased so that base
claims projected reimbursement is increased by an amount
equal to the funds allocated in paragraph (3) of subsection
(b) of Section 5A-12.6, less the amount allocated under
paragraphs (8) and (9) of this subsection and paragraphs
(3) and (4) of subsection (b) multiplied by 40%. Beginning
July 1, 2023 the statewide-standardized amount for
inpatient general acute care services shall be uniformly
increased so that base claims projected reimbursement is
increased by an amount equal to the funds allocated in
paragraph (4) of subsection (b) of Section 5A-12.6, less
the amount allocated under paragraphs (8) and (9) of this
subsection and paragraphs (3) and (4) of subsection (b)
multiplied by 40%.
(11) Beginning July 1, 2018, the reimbursement for
inpatient rehabilitation services shall be increased by
the addition of a $96 per day add-on.
Beginning July 1, 2020, the reimbursement for
inpatient rehabilitation services shall be uniformly
increased so that the $96 per day add-on is increased by an
amount equal to the funds allocated in paragraph (2) of
subsection (b) of Section 5A-12.6, less the amount
allocated under paragraphs (8) and (9) of this subsection
and paragraphs (3) and (4) of subsection (b) multiplied by
0.9%.
Beginning July 1, 2022, the reimbursement for
inpatient rehabilitation services shall be uniformly
increased so that the $96 per day add-on as adjusted by the
July 1, 2020 increase, is increased by an amount equal to
the funds allocated in paragraph (3) of subsection (b) of
Section 5A-12.6, less the amount allocated under
paragraphs (8) and (9) of this subsection and paragraphs
(3) and (4) of subsection (b) multiplied by 0.9%.
Beginning July 1, 2023, the reimbursement for
inpatient rehabilitation services shall be uniformly
increased so that the $96 per day add-on as adjusted by the
July 1, 2022 increase, is increased by an amount equal to
the funds allocated in paragraph (4) of subsection (b) of
Section 5A-12.6, less the amount allocated under
paragraphs (8) and (9) of this subsection and paragraphs
(3) and (4) of subsection (b) multiplied by 0.9%.
(b) Outpatient hospital services. Effective for dates of
service on and after July 1, 2014, reimbursement for outpatient
services shall utilize the Enhanced Ambulatory Procedure
Grouping (E-APG) software, version 3.7 distributed by 3MTM
Health Information System.
(1) The Department shall establish Medicaid weighting
factors to be used in the reimbursement system established
under this subsection. The initial weighting factors shall
be the weighting factors as published by 3M Health
Information System, associated with Version 3.7.
(2) The Department shall establish service specific
statewide-standardized amounts to be used in the
reimbursement system.
(A) The initial statewide standardized amounts,
with the labor portion adjusted by the Calendar Year
2013 Medicare Outpatient Prospective Payment System
wage index with reclassifications, shall be published
by the Department on its website no later than 10
calendar days prior to their effective date.
(B) The Department shall establish adjustments to
the statewide-standardized amounts for each Critical
Access Hospital, as designated by the Department of
Public Health in accordance with 42 CFR 485, Subpart F.
The EAPG standardized amounts are determined
separately for each critical access hospital such that
simulated EAPG payments using outpatient base period
paid claim data plus payments under Section 5A-12.4 of
this Code net of the associated tax costs are equal to
the estimated costs of outpatient base period claims
data with a rate year cost inflation factor applied.
(3) In addition to the statewide-standardized amounts,
the Department shall develop adjusters to adjust the rate
of reimbursement for critical Medicaid hospital outpatient
providers or services, including outpatient high volume or
safety-net hospitals. Beginning July 1, 2018, the
outpatient high volume adjustor shall be increased to
increase annual expenditures associated with this adjustor
by $79,200,000, based on the State Fiscal Year 2015 base
year data and this adjustor shall apply to public
hospitals, except for large public hospitals, as defined
under 89 Ill. Adm. Code 148.25(a).
(4) Beginning July 1, 2018, in addition to the
statewide standardized amounts, the Department shall make
an add-on payment for outpatient expensive devices and
drugs. This add-on payment shall at least apply to claim
lines that: (i) are assigned with one of the following
EAPGs: 490, 1001 to 1020, and coded with one of the
following revenue codes: 0274 to 0276, 0278; or (ii) are
assigned with one of the following EAPGs: 430 to 441, 443,
444, 460 to 465, 495, 496, 1090. The add-on payment shall
be calculated as follows: the claim line's covered charges
multiplied by the hospital's total acute cost to charge
ratio, less the claim line's EAPG payment plus $1,000,
multiplied by 0.8.
(5) Beginning July 1, 2018, the statewide-standardized
amounts for outpatient services shall be increased so that
base claims projected reimbursement is increased by an
amount equal to the funds allocated in paragraph (1) of
subsection (b) of Section 5A-12.6, less the amount
allocated under paragraphs (8) and (9) of subsection (a)
and paragraphs (3) and (4) of this subsection multiplied by
46%. Beginning July 1, 2020, the statewide-standardized
amounts for outpatient services shall be increased so that
base claims projected reimbursement is increased by an
amount equal to the funds allocated in paragraph (2) of
subsection (b) of Section 5A-12.6, less the amount
allocated under paragraphs (8) and (9) of subsection (a)
and paragraphs (3) and (4) of this subsection multiplied by
46%. Beginning July 1, 2022, the statewide-standardized
amounts for outpatient services shall be increased so that
base claims projected reimbursement is increased by an
amount equal to the funds allocated in paragraph (3) of
subsection (b) of Section 5A-12.6, less the amount
allocated under paragraphs (8) and (9) of subsection (a)
and paragraphs (3) and (4) of this subsection multiplied by
46%. Beginning July 1, 2023, the statewide-standardized
amounts for outpatient services shall be increased so that
base claims projected reimbursement is increased by an
amount equal to the funds allocated in paragraph (4) of
subsection (b) of Section 5A-12.6, less the amount
allocated under paragraphs (8) and (9) of subsection (a)
and paragraphs (3) and (4) of this subsection multiplied by
46%.
(c) In consultation with the hospital community, the
Department is authorized to replace 89 Ill. Admin. Code 152.150
as published in 38 Ill. Reg. 4980 through 4986 within 12 months
of the effective date of this amendatory Act of the 98th
General Assembly. If the Department does not replace these
rules within 12 months of the effective date of this amendatory
Act of the 98th General Assembly, the rules in effect for
152.150 as published in 38 Ill. Reg. 4980 through 4986 shall
remain in effect until modified by rule by the Department.
Nothing in this subsection shall be construed to mandate that
the Department file a replacement rule.
(d) Transition period. There shall be a transition period
to the reimbursement systems authorized under this Section that
shall begin on the effective date of these systems and continue
until June 30, 2018, unless extended by rule by the Department.
To help provide an orderly and predictable transition to the
new reimbursement systems and to preserve and enhance access to
the hospital services during this transition, the Department
shall allocate a transitional hospital access pool of at least
$290,000,000 annually so that transitional hospital access
payments are made to hospitals.
(1) After the transition period, the Department may
begin incorporating the transitional hospital access pool
into the base rate structure; however, the transitional
hospital access payments in effect on June 30, 2018 shall
continue to be paid, if continued under Section 5A-16.
(2) After the transition period, if the Department
reduces payments from the transitional hospital access
pool, it shall increase base rates, develop new adjustors,
adjust current adjustors, develop new hospital access
payments based on updated information, or any combination
thereof by an amount equal to the decreases proposed in the
transitional hospital access pool payments, ensuring that
the entire transitional hospital access pool amount shall
continue to be used for hospital payments.
(d-5) Hospital transformation program. The Department, in
conjunction with the Hospital Transformation Review Committee
created under subsection (d-5), shall develop a hospital
transformation program to provide financial assistance to
hospitals in transforming their services and care models to
better align with the needs of the communities they serve. The
payments authorized in this Section shall be subject to
approval by the federal government.
(1) Phase 1. In State fiscal years 2019 through 2020,
the Department shall allocate funds from the transitional
access hospital pool to create a hospital transformation
pool of at least $262,906,870 annually and make hospital
transformation payments to hospitals. Subject to Section
5A-16, in State fiscal years 2019 and 2020, an Illinois
hospital that received either a transitional hospital
access payment under subsection (d) or a supplemental
payment under subsection (f) of this Section in State
fiscal year 2018, shall receive a hospital transformation
payment as follows:
(A) If the hospital's Rate Year 2017 Medicaid
inpatient utilization rate is equal to or greater than
45%, the hospital transformation payment shall be
equal to 100% of the sum of its transitional hospital
access payment authorized under subsection (d) and any
supplemental payment authorized under subsection (f).
(B) If the hospital's Rate Year 2017 Medicaid
inpatient utilization rate is equal to or greater than
25% but less than 45%, the hospital transformation
payment shall be equal to 75% of the sum of its
transitional hospital access payment authorized under
subsection (d) and any supplemental payment authorized
under subsection (f).
(C) If the hospital's Rate Year 2017 Medicaid
inpatient utilization rate is less than 25%, the
hospital transformation payment shall be equal to 50%
of the sum of its transitional hospital access payment
authorized under subsection (d) and any supplemental
payment authorized under subsection (f).
(2) Phase 2. During State fiscal years 2021 and 2022,
the Department shall allocate funds from the transitional
access hospital pool to create a hospital transformation
pool annually and make hospital transformation payments to
hospitals participating in the transformation program. Any
hospital may seek transformation funding in Phase 2. Any
hospital that seeks transformation funding in Phase 2 to
update or repurpose the hospital's physical structure to
transition to a new delivery model, must submit to the
Department in writing a transformation plan, based on the
Department's guidelines, that describes the desired
delivery model with projections of patient volumes by
service lines and projected revenues, expenses, and net
income that correspond to the new delivery model. In Phase
2, subject to the approval of rules, the Department may use
the hospital transformation pool to increase base rates,
develop new adjustors, adjust current adjustors, or
develop new access payments in order to support and
incentivize hospitals to pursue such transformation. In
developing such methodologies, the Department shall ensure
that the entire hospital transformation pool continues to
be expended to ensure access to hospital services or to
support organizations that had received hospital
transformation payments under this Section.
(A) Any hospital participating in the hospital
transformation program shall provide an opportunity
for public input by local community groups, hospital
workers, and healthcare professionals and assist in
facilitating discussions about any transformations or
changes to the hospital.
(B) As provided in paragraph (9) of Section 3 of
the Illinois Health Facilities Planning Act, any
hospital participating in the transformation program
may be excluded from the requirements of the Illinois
Health Facilities Planning Act for those projects
related to the hospital's transformation. To be
eligible, the hospital must submit to the Health
Facilities and Services Review Board certification
from the Department, approved by the Hospital
Transformation Review Committee, that the project is a
part of the hospital's transformation.
(C) As provided in subsection (a-20) of Section
32.5 of the Emergency Medical Services (EMS) Systems
Act, a hospital that received hospital transformation
payments under this Section may convert to a
freestanding emergency center. To be eligible for such
a conversion, the hospital must submit to the
Department of Public Health certification from the
Department, approved by the Hospital Transformation
Review Committee, that the project is a part of the
hospital's transformation.
(3) Within 6 months after the effective date of this
amendatory Act of the 100th General Assembly, the
Department, in conjunction with the Hospital
Transformation Review Committee, shall develop and adopt,
by rule, the goals, objectives, policies, standards,
payment models, or criteria to be applied in Phase 2 of the
program to allocate the hospital transformation funds. The
goals, objectives, and policies to be considered may
include, but are not limited to, achieving unmet needs of a
community that a hospital serves such as behavioral health
services, outpatient services, or drug rehabilitation
services; attaining certain quality or patient safety
benchmarks for health care services; or improving the
coordination, effectiveness, and efficiency of care
delivery. Notwithstanding any other provision of law, any
rule adopted in accordance with this subsection (d-5) may
be submitted to the Joint Committee on Administrative Rules
for approval only if the rule has first been approved by 9
of the 14 members of the Hospital Transformation Review
Committee.
(4) Hospital Transformation Review Committee. There is
created the Hospital Transformation Review Committee. The
Committee shall consist of 14 members. No later than 30
days after the effective date of this amendatory Act of the
100th General Assembly, the 4 legislative leaders shall
each appoint 3 members; the Governor shall appoint the
Director of Healthcare and Family Services, or his or her
designee, as a member; and the Director of Healthcare and
Family Services shall appoint one member. Any vacancy shall
be filled by the applicable appointing authority within 15
calendar days. The members of the Committee shall select a
Chair and a Vice-Chair from among its members, provided
that the Chair and Vice-Chair cannot be appointed by the
same appointing authority and must be from different
political parties. The Chair shall have the authority to
establish a meeting schedule and convene meetings of the
Committee, and the Vice-Chair shall have the authority to
convene meetings in the absence of the Chair. The Committee
may establish its own rules with respect to meeting
schedule, notice of meetings, and the disclosure of
documents; however, the Committee shall not have the power
to subpoena individuals or documents and any rules must be
approved by 9 of the 14 members. The Committee shall
perform the functions described in this Section and advise
and consult with the Director in the administration of this
Section. In addition to reviewing and approving the
policies, procedures, and rules for the hospital
transformation program, the Committee shall consider and
make recommendations related to qualifying criteria and
payment methodologies related to safety-net hospitals and
children's hospitals. Members of the Committee appointed
by the legislative leaders shall be subject to the
jurisdiction of the Legislative Ethics Commission, not the
Executive Ethics Commission, and all requests under the
Freedom of Information Act shall be directed to the
applicable Freedom of Information officer for the General
Assembly. The Department shall provide operational support
to the Committee as necessary.
(e) Beginning 36 months after initial implementation, the
Department shall update the reimbursement components in
subsections (a) and (b), including standardized amounts and
weighting factors, and at least triennially and no more
frequently than annually thereafter. The Department shall
publish these updates on its website no later than 30 calendar
days prior to their effective date.
(f) Continuation of supplemental payments. Any
supplemental payments authorized under Illinois Administrative
Code 148 effective January 1, 2014 and that continue during the
period of July 1, 2014 through December 31, 2014 shall remain
in effect as long as the assessment imposed by Section 5A-2
that is in effect on December 31, 2017 remains is in effect.
(g) Notwithstanding subsections (a) through (f) of this
Section and notwithstanding the changes authorized under
Section 5-5b.1, any updates to the system shall not result in
any diminishment of the overall effective rates of
reimbursement as of the implementation date of the new system
(July 1, 2014). These updates shall not preclude variations in
any individual component of the system or hospital rate
variations. Nothing in this Section shall prohibit the
Department from increasing the rates of reimbursement or
developing payments to ensure access to hospital services.
Nothing in this Section shall be construed to guarantee a
minimum amount of spending in the aggregate or per hospital as
spending may be impacted by factors including but not limited
to the number of individuals in the medical assistance program
and the severity of illness of the individuals.
(h) The Department shall have the authority to modify by
rulemaking any changes to the rates or methodologies in this
Section as required by the federal government to obtain federal
financial participation for expenditures made under this
Section.
(i) Except for subsections (g) and (h) of this Section, the
Department shall, pursuant to subsection (c) of Section 5-40 of
the Illinois Administrative Procedure Act, provide for
presentation at the June 2014 hearing of the Joint Committee on
Administrative Rules (JCAR) additional written notice to JCAR
of the following rules in order to commence the second notice
period for the following rules: rules published in the Illinois
Register, rule dated February 21, 2014 at 38 Ill. Reg. 4559
(Medical Payment), 4628 (Specialized Health Care Delivery
Systems), 4640 (Hospital Services), 4932 (Diagnostic Related
Grouping (DRG) Prospective Payment System (PPS)), and 4977
(Hospital Reimbursement Changes), and published in the
Illinois Register dated March 21, 2014 at 38 Ill. Reg. 6499
(Specialized Health Care Delivery Systems) and 6505 (Hospital
Services).
(j) Out-of-state hospitals. Beginning July 1, 2018, for
purposes of determining for State fiscal years 2019 and 2020
the hospitals eligible for the payments authorized under
subsections (a) and (b) of this Section, the Department shall
include out-of-state hospitals that are designated a Level I
pediatric trauma center or a Level I trauma center by the
Department of Public Health as of December 1, 2017.
(k) The Department shall notify each hospital and managed
care organization, in writing, of the impact of the updates
under this Section at least 30 calendar days prior to their
effective date.
(Source: P.A. 98-651, eff. 6-16-14; 99-2, eff. 3-26-15.)
Section 95. No acceleration or delay. Where this Act makes
changes in a statute that is represented in this Act by text
that is not yet or no longer in effect (for example, a Section
represented by multiple versions), the use of that text does
not accelerate or delay the taking effect of (i) the changes
made by this Act or (ii) provisions derived from any other
Public Act.
Section 99. Effective date. This Act takes effect upon
becoming law, but this Act does not take effect at all unless
Senate Bill 1573 of the 100th General Assembly, as amended,
becomes law.
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